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Start the Conversation: Talking to a Veteran Patient About Suicide
Mental health challenges affect people differently and can stem from a wide range of situations. Some Veterans are coping with aging, stress, or the lingering effects of trauma — whether physical or emotional — stemming from their military service. Returning Veterans may experience difficulty with their relationships or the transition back to civilian life.
Although some Veterans may be honest with their physician about the challenges they’re experiencing, others may not. If you notice your patient is showing warning signs of mental health challenges, it’s important to open up a line of communication. Your trusted counsel could be the turning point that encourages a Veteran to get help before they reach a crisis point.
Know the Warning Signs of Crisis and Suicide Risk
Though not all distressing thoughts and emotions lead to a crisis, if left unchecked, they could become a serious issue with time. Learning to recognize the signs of crisis and suicide risk is an important first step in understanding if someone you care about needs immediate help. Although many Veterans may not show any signs of intent to harm themselves before doing so, some behaviors — such as sleeping excessively or not at all, engaging in risky or reckless behaviors, having dramatic mood changes or deep sadness, or giving away prized possessions — may indicate the Veteran is in crisis and at greater risk of suicide.
The best way to find out if a Veteran you know is thinking about suicide is to ask. Remember: Asking people if they’re having thoughts of suicide will not put the idea into their heads or increase their risk of harming themselves. In fact, a Veteran who is contemplating suicide may welcome the chance to talk about their feelings. Talking may also help them feel less alone.
If your Veteran patient is showing warning signs of crisis, please call the Veterans Crisis Line, chat online, or send a text message today.
How to Talk to a Veteran About Their Emotional Pain
The best way to find out if your patient is thinking about suicide is to ask. Here are some ways you can initiate a conversation with a Veteran who may be in crisis, focusing on your own observations:
- "You seem distant. What’s going on?"
- "I’ve noticed you seem anxious, and I’m wondering how you’re doing."
- "You don’t seem like yourself. I’m worried about you and I'm curious about how you’re feeling."
Once you’ve started the conversation, you can begin to ask questions like:
- "How long have you been feeling like this?"
- "Can you tell me what you think made you begin to feel this way?"
- "Are you having thoughts of hurting yourself?"
- "Are you having thoughts of suicide?"
- "What can I do to best support you right now?"
- "What do you think about getting help?"
Asking whether your patient is having thoughts of hurting themself or thinking about suicide may seem extreme — especially if their troubles seem minor — but it is important. Many Veterans may not show clear signs of intent to harm themselves before doing so, but will answer direct questions about their intent to do so when asked. If you are starting a conversation because you are concerned about emotional or behavioral changes you see, questions about self-harm should be a part of that conversation.
How to Assess the Level of Immediate Danger
Conducting a suicide risk assessment can help you determine the level of danger a Veteran may be in. A suicide risk assessment should evaluate three domains: suicidal thoughts, intent, and behavior. The suicide risk assessment should also consider compounding or protective factors that may increase or decrease the patient’s risk for suicide.
Consider the following points to understand the varying levels of risk for suicide:
- Low – Some suicidal thoughts. No suicide plan. Say they won’t hurt themselves.
- Moderate – Suicidal thoughts. Vague plan for self-harm that isn’t very lethal. Say they won’t hurt themselves.
- High – Suicidal thoughts. Specific plan for self-harm that is highly lethal. Say they won’t hurt themselves.
- Severe – Suicidal thoughts. Specific plan that is highly lethal — including the means to kill themselves and a time set for doing it. Say they will kill themselves.
If you have determined the Veteran is in crisis, you can ask the following questions to help evaluate their immediate risk for suicide:
- "Are you going to kill yourself?"
- "Do you have a plan for how you would kill yourself?"
- "Do you have what you need to carry out your plan (pills, a gun, etc.)?"
- "Do you know when you would do it?"
If a suicide attempt seems likely, call the Veterans Crisis Line, dial 911, or take the Veteran to an emergency room. If possible, make sure the Veteran does not have access to dangerous objects such as guns, drugs, or knives.
For more information on assessing suicide risk, consider the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline Summary and pocket pard. You can also use VA’s Community Provider Toolkit that includes tools to augment the mental health services you provide to Veterans, including resources for suicide prevention.
Remember: You can make a difference, and it starts with one conversation.