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Talking about suicide: ASIST program is combat life saver aid for the mind

Story by Master Sgt. Daniel Palermo
Task Force Spartan

CAMP ARIFJAN, Kuwait — People have preconceived notions about suicide, and it’s not a topic most will discuss willingly. It’s a subject some people would rather ignore, in hopes that they will never have to deal with it. When people are at risk for suicide, they may reveal signs or make indicative statements. To help reduce the stigma associated with personal distress, it’s important to know how you can help when a person at risk of suicide reveals their darkest feelings. It’s better to be prepared to talk about suicide when a battle buddy, friend, or family member confides in you they no longer want to live.

Would you be able to recognize the signs of someone in a suicide state of mind? Would you know what to say if someone told you, “I want to kill myself?” Would you know how to assist someone to safety until they get the professional help they need? These are the questions to ask yourself when deciding if you should attend an Applied Suicide Intervention Skills Training (ASIST) workshop.

The Army’s two prominent suicide deterrent curriculums are; Ask, Care, Escort (ACE) and ASIST.

ACE is approximately one and half hours of training in a small or large group setting. The ACE training helps make soldiers aware of the problem of suicide, enables them to recognize when a fellow soldier exhibits warning signs and equips soldiers with the knowledge and skills to apply the ACE methodology.

ASIST is a two-day workshop that teaches soldiers how to carry out life-saving interventions for people at risk of suicide. The workshop teaches soldiers to recognize when someone may be at risk of suicide and how to work with them to create a plan that will support their immediate safety.

“ACE and ASIST actually work well together but they are two different programs. ACE is more of a hip-pocket training that provides a broad overview about suicide prevention and recognizing warning signs. The ASIST is more of an intervention to assist in what to do at a particular moment,” said, Chaplain (Capt.) Jarrod Foerster of Mobile, Ala., 1st Battalion 62nd Air Defense Artillery (ADA), currently serving with the 11th Air Defense Artillery Brigade.

According to Canada’s Center for Suicide Prevention, “ASIST is an intensive, interactive, and practice-dominated course designed to help caregivers recognize and review risk, and intervene to prevent the immediate risk of suicide.” The Center says ASIST is by far the most widely used, acclaimed and researched suicide intervention training workshop in the world.

The ASIST workshop provides information on how to understand the needs of a person at risk of suicide, learn suicide first aid intervention measures, recognize the warning signs and learn what professional resources are available. The workshop provides life-saving measures and skills needed to apply a figurative tourniquet, or first aid bandage to someone thinking of suicide. It teaches participants how to listen to a person at risk and get them to safety.

ASIST trainers liken their program to the Army Combat Life Saver course. The purpose of CLS is to provide care to wounded soldiers, to stabilize them during the first few crucial minutes after becoming injured until they can be treated by trained medical personnel. Combat lifesavers are non-medical providers that bridge an immediate gap to provide emergency care that saves lives.

“ASIST is CLS for the mind,” said, workshop facilitator, Sgt. Miranda Hayes of Fort Campbell, Ky., a behavior health technician with the 75th Combat Support Hospital. “It gives soldiers the skills to help someone in a suicidal crisis. If a lifeguard sees someone drowning, they are not going to go look for a paramedic before they would attempt to save the person. You can provide help at that particular moment. Everyone is a lifeguard! You can provide immediate assistance until they can get professional help.”

Among a recent ASIST class of 30 participants, 10 had previous thoughts of committing suicide, and 17 knew someone who had committed suicide. Although, the facilitators indicated that these statistic were higher than normal, they also noted that it is typical to have several participants per class who had firsthand experience with suicide.
According to the Department of Defense, military personnel tend to commit suicide at twice the rate of civilians. In a DoD Quarterly Suicide Report for 4th Quarter Calendar Year 2016, military services reported the following:

• 76 deaths by suicide in the Active Component
• 20 deaths by suicide in the Reserves
• 30 deaths by suicide in the National Guard

“I have a close friend who committed suicide last year,” said Spc. John Pfautz, Bravo Company (Intelligence and Sustainment), 28th Infantry Division. “We must have empathy for others. In the Army, we get in this mindset that all soldiers need to meet the same standards. We are taught to be soldiers 24/7 whether we are off or on duty. However, we need to take a timeout and help a battle buddy in their time of need.”

Facilitators point out that suicide is an extremely emotional subject, and it is especially difficult for those who have lost someone to suicide.

At times during the ASIST workshop, participants fought back tears and strained to speak while trying to share their experiences related to suicide. There were moments when the room was completely silent, as participants waited patiently for a classmate to gather enough composure to speak. Although it is a discussion that’s difficult to initiate, as one suicide story was shared, it was slowly followed by several others.

“I had an employee about three years ago that committed suicide,” said Spc. Jordan Myers, 176th Financial Management Support Detachment, 38th Sustainment Brigade. “From the information taught in this course, I feel more prepared to discuss the topic without skirting around the issues. It taught me how to open up to somebody. You have to learn to recognize some of the emotional changes and body language. One of the first steps I would take is to get them to open up a little bit more.”

Most people who think about committing suicide don’t actually want to die. According to the ASIST program, they need help understanding why to stay alive. ASIST does not attempt to find the root cause that brought the individual to consider committing suicide. It provides soldiers with communication tools that empower the receiver to hear the story of the individual contemplating suicide, and find ways to support him or her and get that individual to safety. ASIST provides information on how to detect “invitations,” subtle hints or signs that can alert the receiver when an individual has behaviors or thoughts of suicidal.

“What does it mean to hear their story? Perhaps an individual is depressed, not necessarily suicidal, but severely depressed. ASIST teaches how to have a conversation — not on how to solve their problem, but how to come up with a plan on what they are going to do to seek help. Participants in ASIST learn how to guide the conversation for persons at risk to see a chaplain, behavioral health specialist, counselor, therapist or a psychiatrist,” said Foerster.

The suicide rate in the military used to be lower than the population at large. However, in the years following the start of the wars in Afghanistan and Iraq, service members began taking their own lives in increasing numbers.

USA Today reported in 2016 that the Army’s suicide rate for active-duty soldiers averaged nearly 11 per 100,000 from Sept. 11, 2001, until shortly after the Iraq invasion in 2004. It more than doubled over the next five years, and, with the exception of a spike in 2012, has remained largely constant at 24 to 25 suicides per 100,000, which is roughly 20-25 percent higher than a civilian population of the same age and gender makeup as the military.

Individual soldiers have varying levels of coping abilities in terms of dealing with stress attributed to deployment, separation from loved ones, divorce, illness, loss of job, and death of a comrades or family members. What does it take for a soldier to reach a state where they feel trapped, reckless, and hopeless, drowning in depression with no hope or sense of purpose?

Triggers that push individual soldiers toward committing suicide are unique to each person. Therefore, it is important to prepare yourself, as a battle buddy, to be a skilled and trained listener. You may be that lifeguard who could help save a drowning comrade.

“This course provided a lot of helpful tools. It taught me to learn how to communicate with someone going through a crisis, possibly someone considering suicide,” said, 1st Lt. Robert Connors, Headquarter Support Company (Training and exercises unit), 28th Infantry Division. “I learned ways to effectively communicate with them, and to develop a plan to help them get through their time of need. It taught me how to be open and blunt to talk about suicide. If this course helps save one person from taking their life, then it’s worth having everyone be ASIST certified.”

ASIST is available to soldier, regardless of rank, to become suicide prevention liaisons for their respective units. Leaders are encouraged to allow soldiers to participate in an ASIST workshop.

“It’s not necessarily that the desire to attend the workshop isn’t there,” said Hayes. “I understand units are very busy and it’s hard to excuse a soldier, especially for two days, in high-tempo environments. However, this course is extremely beneficial. Most students leave here with a much better understanding of how to help somebody in time of need.”

According to the U.S. Army Suicide Prevention Program website, “Suicide prevention, like all leadership challenges, is a commander’s program and every leader’s responsibility at all levels. The success of the Army Suicide Prevention Program rests upon proactive, caring and courageous people who recognize the imminent danger and then take immediate action to save a life. Active engagement of everyone can help to minimize the risk of suicide within the Army to stop this tragic and unnecessary loss of human life. Suicide prevention is everybody’s business in The Army.”

Army personnel interested in attending ASIST training should contact their command suicide prevention program manager for course locations, dates, availability and enrollment information

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