How can civilian providers address suicide?
[Lt. Col. Jeffrey Yarvis] For the civilian providers that you mentioned,
even adding to their algorithm, "Have you ever served in the military?
Has your service happened recently?
Did you deploy?
And are there any things that you've seen
or felt or did that might make you feel depressed, anxious, guilty?
And if so, have you ever had thoughts of harming yourself
or others to include wanting to die?"
And you're very professional and matter of fact about it.
And what's really interesting about that is
I think people will have this myth that if you ask somebody about suicidality,
you might actually promote it.
It's actually the opposite.
People are very matter of fact, and they'll say, yes, I've had those thoughts.
And then you can—if they endorse that,
then you can find out to what extent is this serious,
and— "Do you have a plan? How many plans do you have?
Have you acted on that plan?
Have you started actually doing the things in preparation for your death?"
Because now you know how serious this is.
But if they say, "Yeah, I've thought about it, but I have
a wife and children, and I would never do that,
it's a very selfish act,
or as dark as those thoughts are, I can't imagine that."
Then you can even normalize that behavior and say,
"Well, that's not uncommon."
If it ever—and then you can talk to them about what those other thresholds are,
and say, "If it ever reaches this threshold,
or you're not even comfortable with that thought,
here's how you access us."
And that access can be, "Don't worry about it if you can't get a hold of me,
you can go to the emergency department,
you can let a friend or a commander know."
But we're creating a culture, we're talking about death and dying as an open thing,
and not just about suicidality.
Our society in general is not comfortable with talking about death,
and--where other cultures really talk about it quite openly.
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Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.
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