ACE Suicide Prevention Lesson 1.0

1. ACE Suicide Prevention Lesson 1.0

2. What does ACE stand for? A = Ask C= Care E= Escort

3. Why use ACE? • “ACE” teaches Soldiers how to recognize suicidal behavior in fellow Soldiers and the warning signs that accompany it • “ACE” targets those Soldiers most at risk for suicide and the least likely to seek help due to stigma • “ACE” increases a Soldier’s confidence to ask if a battle buddy is thinking of suicide

4. What are some individual protective factors • Cultural and religious beliefs that discourage suicide • Support through ongoing mental health care • Self esteem, direction, and optimism • Unit Chaplain and or ministry team

5. Individual protective Factors continued 5) Reason to live 6) Family support 7) Pride and patriotism for military service

6. ASK • Ask your battle buddy about his or her suicidal thoughts • Know the warning signs you might see in yourself or battle buddy if he or she is suicidal. Look for any outward sign that shows a deviation from your battle buddy’s usual self • When the warning signs are present, it is imperative to ask your battle buddy directly; “Are you thinking about killing yourself”?

7. Care • Carefor your battle buddy by understanding that your battle buddy may be in pain. Active listening may produce relief. Calmly control the situation: do not use force. Take action by removing any lethal means, such as weapons or pills • Important to understand with what, where, and when the battle buddy plans to kill himself or herself. The fact your battle buddy acknowledges his or her plans generally suggests that they are accepting help

8. Escort • Escortyour battle buddy immediately to your chain of command, Chaplain, or behavioral health profession • Don’t keep your battle buddy’s suicidal behavior a secret. Adopting an attitude that you are going to help your battle buddy will save his or her life • Stay with your buddy until he or she receives appropriate help. Don’t leave your battle buddy alone • Being there for your battle buddy will make the difference

9. Who can help you? A. In Garrison: • Unit Chaplain; Unit Ministry Teams • Family Life Chaplains • Army Community Services • Medical Services (Behavioral Health or Primary Care) • Marriage and Family Counselors • Post Deployment Centers

10. Who can help you? B. During Deployment: • Combat Stress Control Teams • Medics • Battalion Aid Station • Chaplain & Unit Ministry Teams

11. Suicide Prevention Lesson 1.2 Case Studies

13. Welcome to Military Life Virtual Environment Tasks: • Student will create an Avatar to engage in the virtual world 2)Student must first interact with three specific recorded avatars to learn more about suicide prevention. 3)After meeting with three Avatars the Virtual Environment will be unlocked. Students then can interact with each other and discuss at least one of the cases with a classmate. 4) After the virtual experience students will enter testing area answer review questions and discussion questions about suicide prevention.

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15. Welcome to Military Life user

16. Go find Eric in Classroom #1

17. Eric will share his story

18. TEXT Based Version of Eric’s Story • Case Study One • A Case Study on Suicide • Eric's dad died when Eric was 15. They had been very close, so when his mom remarried about a year later, Eric had a hard time adjusting. His stepdad talked about how much God loved him, but Eric didn't want to hear it... just like he didn't want to hear the stranger in the school assembly say things get better; that suicide isn't any answer. Eric had lived through three years of anger, pain, and emptiness looking for better. It didn't exist. • Drugs and alcohol numbed the pain. Eric remembers: "What really led me into suicide was drugs and alcohol. I never figured I would get to that point. It started when I was probably 10 years old, smoking grapevines in the woods behind our house." • Eric separated himself from reality and from the people who loved him. "There were people in my life that cared about me," Eric said. "The way I wrote to them in my suicide letters was so deep. Why couldn't I go to them and say, 'I am about to kill myself. I need your help'? The world of drugs I was in separated me from my relationship with them." • On Thanksgiving Day, 1990, Eric hit bottom. Already in danger of losing his driver's license, he got another ticket. He was already facing a possible $5,000 fine or 30 days in jail for possession of deer out of season. Also, he could lose his guns, all handed down to him by his father. • As he lay in bed that night, he felt tired. Tired of the pressure. Tired of the anger. Tired of the hurt. Tired of living. • He got out of bed and put on his best clothes. He wrote his will and good-bye letters to his family and friends. He was so angry at his father for dying, he decided to kill himself over his father's grave. Eric sat in the cemetery with his roommate's rifle under his chin. He tried to pull the trigger, but couldn't. He tried again and again. Completely frustrated with himself, he downed a fifth of whiskey. Then he put the rifle under his chin and pulled the trigger. • At 4 a.m. Eric lay in his own blood, unable to move a muscle. He couldn't see, or hear, or yell for help. But he could feel pain. • Was he dead? Was this hell? If he was still alive, would he be left here to bleed to death? Eric had put himself to the test, and now he knew he didn't want to die. It was his senior year. He wanted to live, to find the right answers, a way out of the pain. But he had chosen a highway to nowhere. Was this the end? • Who could he turn to? Who would help him? In that dark moment, Eric remembered the things his stepfather had told him--that God loved him and was always there for him if he'd only ask. For the first time in his life Eric prayed, "God, I need your help."

19. Eric’s Story finished • The police report from that night shows God's intervention. Eric managed to get to his car and pull himself into the driver's seat. The sheriff's department clocked Eric at speeds over 110 M.P.H. as he drove himself to the hospital. The surgeons worked for 17 hours in emergency reconstructive surgery. He went into a coma. A few weeks later, his aunt sat down on his catheter, and he woke up. • Eric was alive, but the exit he had taken meant bumpy roads ahead. When he looked in the mirror for the first time and saw his disfigured reflection, he cried. Yet he somehow knew that God was there, just as He had been in the cemetery. Tears of anguish became tears of joy as Eric realized how God had spared his life. "That was the day I found hope," Eric said. • Eric had to fight to hold on to that hope. Just as his physical recovery was a process, his spiritual and emotional recovery was step by step. Eric says he didn't even accept Jesus as his Savior until a year after God came to his rescue, and even then he struggled. • "It was instant relief and contentment when I first invited Christ into my life," Eric said. "It was instant peace and joy. And for a period of time I gave up the drugs and alcohol. But all I really focused on was the emotional or sensational aspect of Christianity... the way I felt. There wasn't a real foundation there." • Eric knew God loved him. He knew God could save him from anything, even from himself. But he chose the hard way. He still prayed, but he was not committed to God. Eric said, "I needed an anniversary or something to say, "Okay. This is the day I'm gong to change my life." • One more accident, and Eric had his anniversary. He shattered his ankle mountain climbing. Finally, he understood he couldn't change himself. He turned his life over to God. He started going to church, reading the Bible, and leaning on Christian friends. "It is the actual foundation in the Word that has made my relationship with God what it is; that has made my life what it is today," he says. • Today, Eric is the stranger speaking at school assemblies telling teens suicide isn't the answer. Through T.A.P.S. [Teenage Awareness Preventing Suicide] he is a flesh-and-blood example that there is a way out of their maze of pain. • What does Eric tell teens on the edge? • The answers "I love you" and "You will make it" were not enough for Eric. But when God says it, it's enough. Eric knows that now. His message is the hope Christ brings, not empty promises but PLANS! "For I know the PLANS I have for you,' declares the Lord, "PLANS to prosper you and not to harm you, PLANS to give you hope and a future"--Jeremiah 29:11 [NIV]. • Before Eric tried suicide, he reasoned, "Why would anyone want to go through life wishing for death?" His suicide letters spell out his desire for hope, happiness, and meaning: "I hope I can find a world where I'm happy. I hope I can find this wonderful place called heaven. Keep my memories alive like Dad's. Hopefully in my journey I will find him." • Eric's Heavenly Father found him. God loves him--pain, hurt, confusion, mistakes, even disfigurement included. "When I was in the hospital, my mom didn't care how many scars I came out of there with. She wanted me to live and be happy with my life. God is the same way. He doesn't care what kind of scars you have. All scars show is that you have hurt. And that you've healed.

20. Find Margaret in Classroom #2

21. Margaret will Share her story

22. Text based version of Margaret’s story • Case Study Two • Depression/Suicide Case Study • Margaret B. was married to a tender and loving second husband who catered to both Margaret and her son from her previous marriage. However, she became increasingly unhappy and felt unworthy of both her husband and her son. She thought they deserved a better wife and mother. Her misery led her husband to persuade her to seek psychiatric help. Unfortunately for her, the psychiatrist she consulted was inflexible in his therapy style and was unable to change Margaret's view of herself as ugly and inadequate, although her friends saw her as unusually attractive and bright. • One of Margaret's friends, Vi, met Margaret because the same psychiatrist was treating both of them. Vi was fond of Margaret because they had similar problems, and they visited each other often. On one visit to Margaret's house, Vi found Margaret extremely active and quite chipper, in contrast to her usual depressive and fatigued demeanor. Most people might have regarded that as a great sign of progress, but the change was too radical, and Vi was suspicious. Immediately after leaving Margaret's house, Vi went to the nearest pay telephone and called Margaret's husband Burl to tell him that there was something strange about Margaret's behavior. • Burl rushed home from his office and found Margaret lying in the bathtub with her wrists slashed, bleeding profusely. He applied tourniquets and called an ambulance. Because Vi was astute and Burl was concerned and quick, Margaret survived. Had he been 30 minutes later, she almost certainly wouldn't have. • After this incident, Margaret went to a different psychiatrist who prescribed medication that significantly improved her mood. She still was not an unusually happy person, but her mood was normal, and she did not repeat her suicide attempt. • Margaret's case occurred a long time ago. Nevertheless, it illustrates some facts about depression better than a modern case could. First, it shows that the wrong psychotherapy can be worthless, or worse. Second, it demonstrates the danger of suicide if effective medications and therapy are not administered. Third, Margaret's sudden surprising improvement in mood before her suicide attempt is typical, a sign that the depressed person has made a decision and is relieved about it. That is one of several possible danger signs that should not be ignored (see the discussion of suicide for other signs that should arouse concern).

23. Find James in Classroom #3

24. James will Share his story

25. Text based version of James’ story • Case Study Three • Suicide Indicators: A First Responder’s Experience • Disclaimer: This case study is based on true events. Names have been changed to protect those involved. • It was the spring of 1991 when Airman James had just completed basic training and reported to his next command to start the next phase of his training. Several sailors from his boot camp company had reported to the same training command to continue their training. For most, this was their first time away from home. Only a few of them had been assigned to the barracks as James, but none had been assigned to the same class. Airman James had been assigned to a night school class that was all male ranging in age from 18 to 25 years. • Keeping with tradition, the instructors started the first day by choosing class leaders to serve as the primary point of contact for various class responsibilities. When the class was asked who was most senior, one student, Airman Timmy, raised his hand and blurted out, “I’m going to OCS (Officer Candidate School)!” His declaration invoked a barrage of disparaging and insulting responses from many of the other students in the class and earned Airman Timmy instant status as the least popular member of the class. Rarely did a day pass without Timmy becoming the target of an insult or ridicule. Airman Timmy soon began to try and impress some of his classmates by showing off expensive technology he had purchased or boasting about all he was going to do after he completed training and transferred to the fleet. • Airman James did not get selected as class leader but, instead, was selected to be a duty section leader. This responsibility resulted in his reassignment to a new room with other duty section leaders who worked together to maintain security watches and organize barracks cleaning details. One day, Airman James and his roommate Airman Mark were sitting in their room polishing their boots. Airman Timmy walked in, as he often did on duty days, and began talking about school and how hard thing had been getting. James and Mark continued to polish their boots as they listened to what they thought was Timmy blowing off some steam. Timmy finished his conversation with, “I just don’t know how I can go on…” before turning and leaving the room. James and Mark sat there, mouths open and stunned at what they just heard. James looked at Mark and asked, “Did he just say what I think he said?” Mark replied, “I think he did.” They decided to get up immediately and report what just happened to the instructor standing barracks watch. The instructor told them he would take care of it and sent them on their way.

26. James’ story continued • That evening Airman Timmy was called out of class and taken to the schoolhouse office where he was confronted about the comments he had made to James and Mark. After about an hour passed, Timmy returned to the class and immediately began yelling at Airman James about what he reported. James tried to reason with Timmy for a minute before telling him that this was not the place and time for this conversation and that they could discuss it during their lunch break. When the lunch break time arrived, James tried to talk to Timmy about the events that had transpired. Timmy’s responded by cursing him and telling James to leave him alone. James was a little disturbed by Timmy’s response and a little irritated from being lashed out at by him in the class. But, James also felt that it was good that Timmy was alive and mad at him instead of dead by his own hand. • Airman Timmy never really made friends with any of the other students in the class. His behavior became more negative as the class progressed. He would often submit scathingly negative comments about instructors at the close of instructional blocks and sometimes expressed them verbally. This caused a spiral effect which resulted in disciplinary counseling and the loss of an advanced phase of training. Airman Timmy completed his training and transferred to the fleet. It is not known if he attended OCS or presented any other suicide indicators or gestures again.

27. Chat with other users about suicide prevention

28. Go to Suicide Prevention Testing Center

29. Post-Assessment: Part I Students will answer a variety of multiple choice, true/false questions and write an essay to describe in detail from their selection of one case study, the various components and factors that determine suicide and what should be done or should have been done to prevent it. Essay discussion will include the following:--What risk factors for suicide were present in this case study? --What suicide warning signs are presented in this case study? --Identify the first responders? --Identify when first responders intervene, or should have, and how? --What did the first responders do right? What did they do wrong?

30. References: ILE. (n.d.). Introduction & Overview. Integrated Learning Environment. Retrieved July 15, 2012, from https://ile-help.nko.navy.mil/ile/index.aspx Suicide Prevention and Risk Reduction Committee (SPARRC). (n.d.). DoD/VA suicide outreach | Resources for suicide prevention. SuicideOutreach.org. Retrieved July 22, 2012, from http://www.suicideoutreach.org/ U. S. Air Force (2012). FY 2012 Career development course (CDC) Student satisfaction survey. Maxwell-Gunther AFB, Montgomery, AL: Air University. Retrieved on July 12, 2012 from http://www.au.af.mil/au/afiadl/