Thursday, February 21, 2013

The Cascade Potential of Suicide


*Note: all names and identifiers have been changed, but this story is true.

His name was Michael.  He was in the wrong place at the wrong time when the shooter at Ft. Hood created mayhem, horror, and fear.  His friends knew that the incident, deemed “workplace violence” was never far from his mind, but they thought he was okay.  He was not.  He committed suicide this month.  This did not make the newspapers except in a small obituary, but it sent a resounding echo of despair to his circle of friends.

One friend of his, Jim, reacted very strongly to the news of the suicide.  He became very angry.  He became physically violent toward his wife.  He vehemently threatened systematic destruction of all of his VA doctors (while in the halls of his local VA), and he expressed suicidal intentions.   In each instance, his local VA suicide prevention coordinator was unable to provide help because Jim was not “actively suicidal”.  The Caregiver spoke twice with  the suicide prevention psychologist who said he could not do anything without an in-the-moment attempt.  When saying it makes no sense not to throw a float to a drowning man, his wife said this, “it seems that until you are underwater, going down for the last time, that no one can actually do anything”.

One week later, after two visits to the local ER, (while his wife made careful safety contingency plans for herself), the situation worsened.  Jim took a household knife into the bathroom with him  and attempted suicide. (All firearms had long been removed from the household). When his wife broke into the bathroom, he threatened her with the knife and said he would first kill her, then himself.  Through a near-miracle, she was able to get him to the local ER and began anew to get him VA psychiatric care.  Many calls (some with outside assistance and advocacy) were made to the VA Crisis Line.  Crisis Line recommendations to obtain local VA help went to unanswered voicemail... 

With great compassion but also frustration, it seemed that most everyone’s hands were tied in some way or another, and the hours crept by.  Finally the VA said it would admit Jim, but his wife would have to drive him nearly two hours to the facility – which under the circumstances was potentially too dangerous.  Eventually into the wee hours, the private hospital moved him to a nearby psychiatric facility since no safe transport could be arranged to the VA.  He remains there today, awaiting a private PTSD program.
There are gaps in any system.  However, the current issue is the lack of follow-up by the local VA including his case manager, the suicide prevention coordinator, and the social work office.  The Caregiver is exhausted, emotionally spent, and has no Caregiver Support Coordinator despite being in the National Caregiver Program. They have communicated their situation to leadership at VA for two years.  These at-risk veterans and their families need consistent follow-up after a suicide attempt, and the care gaps back-filled.  There are policies in place to aid in care and recovery.  But – it doesn’t always happen as written.


Please be aware of your fellow veterans and families.  Be aware that the suicide of a friend may create abrupt behavioral changes in your veteran, and in the worst case, lead to another suicide.  Know that long-term frustrations can suddenly spill over and create volatile situations.  And, always have the number of the Crisis Line, an advocate, and a personal support person if this happens to you.  Friends and social media can spread word of suicide in seconds, and information may be wrong, yet the actions some take can be irreversible.

When in doubt, please reach out! And, as caregivers, remember this:  the life you save may be your own.

Blessings and care,

Linda Kreter & the VeteranCaregiver Team

Friday, February 1, 2013

Winter Blahs!


Over the past few weeks I have spoken to a number of families who seem to be struggling in many ways, just to deal with day-to-day life.  One family had multiple health problems with many medical appointments, another had a death which required an out of state trip. Even in my own family we have had various depressing problems.
I went to have coffee with a good friend and I was talking to her about life in general getting harder to deal with.  She looked at me with great seriousness and told me I had caught the Winter Blahs. I laughed thinking she was joking. Well, in part she was but she was also deadly serious.  This time of year is often hardest for families who are caregiving. Getting someone in a wheelchair to hospital appointments can be a nightmare in bad weather. Snow, icy roads and freezing fog combine to make any driving stressful.  Multiple illness in a household causes more stress.  Children can be cooped up in the house with few ways to get rid of excess energy.
I have been trying to think of ways, just small ways, to help get through this part of the year.  For one thing the days of clouds and low light really depresses me so I have switched to full spectrum lights in many parts of my house, especially the lights I use mostly.
I try to find one thing each day to look forward to for myself.  It can be 15 minutes with a good book, a quick manicure or planning my garden for when the spring comes.
 If I have things to do that I really do not want to deal with, I try and do those early in the day if I can. That way they are not nagging at me for hours.
I  get outside in the fresh air even if it is just for a few moments.  I look for joy in small things; an insect creeping up a leaf or a pattern in the clouds (which was always a game when I was a kid). I also remind myself that winter is not going to last and that the sniffles and fog and horrid road trips will be gone soon.
 I get exercise of some sort even if it is with the Wii or the stair stepper. I'll see if I can fit in a new project; being creative is a good cure for the Blahs. Knitting, painting, cooking or sewing are all productive and you can see the results of your work. Right now I am trying to grow some fresh herbs in pots on the window ledge.
Above all the support of friends and family helps. Being stuck together in a small space can make all of us edgy, but  if you can get the family involved with a little planning you can chase away these Winter Blahs.


Tuesday, December 18, 2012

Good Ripples

When I was very small I remember a neighbor coming to our house one day. Her name was Miss Thomas. I don't think my mother knew her well but she had a book for me. It was called The Mystery of Hallowdene Farm.  I think it must have been hers when she was a child because it was printed about 1920.It was just a gentle story for girls and I still have the book among my others.  Every time I look at that worn book I remember Miss Thomas and her one visit to our house.
My point here? It makes me remember how small things can affect others long after they might otherwise be forgotten and it is the small things that make up our day-today existence.

I see my life-actions as a series of ripples, like a stone thrown into a pool. The ripples move out, sometimes they mesh with other ripples and change direction. Sometimes they travel a long distance. We may never know what effect our ripples have. If we send out ripples of caring, love, compassion and understanding, these good ripples may have an effect that we are unaware of, or may never know about. That does not matter. When I smile at a stranger, allow someone ahead of me in the grocery line, say a cheerful word to a grocery store clerk or in other ways bring love and light to the people around me, I am sending out good ripples.
I wonder if a good ripple would have made any difference in the life of the persons who have wielded guns in this past week and taken so many lives.  We are unable to know, but this does not stop me trying to send out all the good ripples I can. I don't know if it would stop a person with murder in his heart. I don’t know if it would help a suicidal person stop and think before committing the act. I do know that I have to try.
The events of this past week are going to with us for a very long time. I cannot think there can be many people in the US who are not appalled by these recent shootings.  It does make me reflect  on the fact that we tend to ignore the small things in our lives.  Just think how good life could be if we all made an effort to send out those good ripples. Best of all it does not cost a thing.
Wishing you all a Blessed Holiday Season.

Wednesday, December 12, 2012

The Basics of Help ...


Greetings, friends,

For many of you, the following information will be basic and instinctive to you.  However, recently we’ve received 35 calls about how to navigate the medical or legislative system, and we thought the following guidance might be helpful.

What do I do when I need caregiver help?

If you are already in the National Caregiver Program, contact your Caregiver Support Coordinator (CSC) at your local VA medical center.  If s/he is not in, ask for the alternate, and leave a voicemail.  It’s a good idea to also follow-up with an email, and their email can usually be found through an Internet search.  You can ask for the email address, and if it’s not forthcoming, ask who else can help you.

If you’re not in the Caregiver Program, you can still use the Caregiver Support Line and request help and guidance.  If your issue is outside the responsibilities of the CSC, then ask who you should be directed to for problem resolution.  It will likely be someone else in the Social Work Office. 

Caregiver Support Line 1-855-260-3274

What do I do when I need help with my Veteran’s medical care?

If you have already spoken with your primary care physician, or in the case of mental health, the psychologist, we suggest contacting various VA advocates.  If your veteran is an OIF/OEF/OND veteran, there is a specific OIF/OEF Coordinator, whose name may be found with an Internet search, a VA website search, or by calling your local VA medical center.  They are often able to cut through issues very simply for you.

If the issue relates to a disagreement over care or other conflict, you would contact the VA Patient Advocate at your local VA.  This person may be found on the VA website, through an Internet search or by calling.  If there is a formal report or complaint to make, ask for the proper forms and be sure to follow all the steps directed so that you will find resolution.  You may need to be quite persistent, and you will need to judge the seriousness of your issue.

What do I do if I need help understanding VA process (paperwork, fee base, etc.)?

The Internet is an excellent source of information, but it may be a huge undertaking to find out the nugget of information needed.  Obtain one of the VA Handbooks on Benefits (you can download it or obtain a hard copy at your local VA) to find out who to talk with for specific needs.  

Why use a VSO?

We also highly recommend contacting one of the chartered Veterans Service Organizations (VSO’s) such as AmVets, Vietnam Vets of America, DAV, the Legion and others.  You can find a list on the va.gov website.  It is highly recommended that you use an organization to help you since VA benefits and processes change with the legislation and it can be a daunting task keeping up with the changes.

The importance of peers is...

Ask your fellow caregivers.  Your peers often have great experiences to share, so post here, write to your friends, and seek out others locally who can provide you practical information.  Seek out others while at the VA and absorb all you can; what you learn will either help you, or others in the future.

This is a starting point...

Linda Kreter & the VeteranCaregiver Team


Sunday, November 11, 2012

Blessings and Gratitude on Veterans Day 2012

Greetings on this Veterans Day 2012,

Our heartfelt thanks to our Veterans today  -- and their entire extended group of family and friends.  We trust that you know that we treat each and every day as Veterans Day, but on this one day set aside each year, we give you special thanks.

We also specifically give thanks to the Caregivers of our wounded, ill, and injured veterans.  We thank the children who grow up very quickly and often also bear the invisible wounds of war with their parents.  We thank parents who care for their adult children and for siblings, extended family and friends who do the same.  The challenges you meet and the way you keep your faces turned to the light mean so much to this land.

Every day the flag flies over the land of the free, it is because of the actions and valor of the brave.  We love our country, and we honor you today with an extra measure of love and care.

God bless you,

Linda and the Veterancaregiver Team


Monday, October 8, 2012

Response to Military Suicide Article



The Pentagon's "Quick" Fix is NO FIX to Military Suicide

By:  Rev. Dr. Chrys L. Parker, J.D., PTSD specialist

It's an unfortunate irony that the Defense Department apparently believes that its proposed ban on servicepersons' privately owned guns will serve as a "silver bullet" that will prevent or reduce suicide among service members. 

Such a proposal, while no doubt well intended, is reflective of the Pentagon's misguided and ineffective search for quick and simplistic answers to complex problems of the human psyche, which are the inevitable product of war.  While the military is undoubtedly skilled in marshalling men and regulating the use of arms on the battlefield, the ongoing battle within the mind of the traumatized and suicidal soldier is of a very different kind.   The skills needed for the first kind of battle are ineffectual in fighting the second. 

The military was designed to fight wars, and does so with competence.   But as an institution, the military was never designed to be the curer of wounded souls.  When confronted with the alarming psychological byproduct of war,  the military seeks to employ "default" solutions which, in its estimation, will fix a problem through the issuance of orders.

 Soldiers do not become suicidal simply because they possess weapons.  And they will not avoid suicide, based on an order not to possess them.  After all, suicide may just as easily be accomplished with a service weapon, and frequently is.  If possession of private weapons is (erroneously) deemed to be the factor which initiates suicide, then we must be led to the ludicrous conclusion that a ban on all weapons, including service weapons, would be in order if we are to really get serious about reducing the rate of military suicide.

 Obviously, the Pentagon is not logically thinking this problem through to its thoroughly illogical conclusion.  In a desperate move to find a quick "fix" that can be implemented by legislation and M.P.'s, instead of through appropriate, empathic and personally rendered care, the military is firing without aiming first.  It seeks to control the means of suicide, without bothering to examine the reasons that warriors adopt those means in the first place. 

And, to be sure,  there are plenty of means that remain available to the suicidal serviceperson, whether private firearms are banned or not.   It is patently obvious that the nameless "senior Defense Department officials," who have concocted the suggested ban on private weapons,   spend little or no time whatsoever actually talking, working, or counseling with REAL suicidal warriors, like the ones I see and counsel every day.  

In coming to illogical conclusions about what drives suicide, or by what means it is accomplished, the Pentagon appears not to learn from its own reports. For proof of that, one may look back at the DoD Epidemiological  Report on Suicide for  the year 2009, which references the number of suicides accomplished by hanging. 

Would the Pentagon therefore propose that we inspect the house of every warrior for rope and seize the household clothesline, as an "effective" plan for suicide reduction?   Having begun with private weapons, and moved on to rope,  should we also plan on banning razors, kitchen knives,  motorcycles,  and automobiles,  which are also prominent instrumentalities of suicide? 

The additional suggestion that prescription drugs be removed from households by spouses of "at risk" soldiers is irrational and ineffective.  It presumes, first, that "at risk" soldiers can be systematically identified.  Suicidal soldiers will be the first to tell you that if they are truly serious about taking their lives, they will deliberately evade identification.

Assuming, however, that a soldier is identified as genuinely "at risk" of suicide, that soldier ought to be in treatment, NOT left sitting in his bathroom contemplating the contents of the medicine cabinet.  Having failed to make adequate treatment accessible, the military is shifting the burden of care to spouses, who are not the proper persons upon whose shoulders the psychiatric management of soldiers should be foisted. 

I am sure that the good intentions of Dr. Jonathan Woodson,  Assistant  Secretary of Defense for Health Affairs, are not to be doubted… only his ability to grasp the obvious.  The "obvious" is that (l) removal of prescription drugs may also serve to defeat the administration of bona fide medical treatment;  (2) removal  of the drugs of one person would  extend to removal of  ALL drugs for  ALL family members ;  and  (3)  a suicidal soldier may obtain lethal drugs from many sources outside the home ,  including the $3.00 bottle of acetaminophen (Tylenol) from the local drug store. 

The illogic of these proposals, not to mention their unconstitutionality, is astonishing.

"Orders" are things the military knows well.  Orders lend, to the military, both the internal feeling and the public perception that  things are "under control."   Orders are calming, because they make it appear that a problem has been put to rest.  But "orders" are also utterly ineffective to salve the deep wounds which cause many warriors to lose all sense of meaning and all desire to live.  The only thing which this proposed order will put to rest, are the lifeless bodies of soldiers who have ended their lives, in countless other ways,  despite the military's "orders" that they not commit suicide by firearm.

 As a mental  health provider,  as a Chaplain in service to military members and veterans, and as a contract military trainer,  it pains me to see the military utilize its time, resources, and talented personnel in continually avoiding the nature of the suicide problem, instead of addressing its underlying realities.

Suicide is not a weapons problem, or a drug problem, any more than it is a rope or razor problem.  It is an existential problem… a deep wound to soul and psyche of incalculable depth, which creates an absolute belief in the mind of the warrior that his or her existence is absolutely of no value or worth.  This is what drives suicide.

What is actually of no value or worth in preventing suicide is the use of weapons bans, prescription bans, or digitized slide shows which attempt to "lecture" despairing soldiers into  living against their will, rather than by providing them the relational care they need.

For some, suicide is the only means of escaping the unremitting terrors of gruesome and horrifying battles that are continually re-enacted in flashbacks which medication cannot remedy.  For others, suicide feels like the only "adequate penance" for intense guilt over having survived when one's buddies did not.  For others it is a reflection of the inability to "occupy" a body or soul that has become soiled by the brutalities of war, or the deaths of others caused by the performance of one's duty. 

Every warrior who suicides has his or her reason.   But whatever the reason, all suicides constitute a "final solution" for  people whose deep personal pain is fed not  by guns, but by mental, social and spiritual isolation, exclusion,  and the knowledge that the relational support  which they experience in the combat theater is no longer present for them when they return to the rear. 

It was my privilege to go to the Iraqi theater in 2010.  Now I understand why warriors are at lesser risk of suicide in theater than they are at home.  There is not a single suicidal warrior whom I counsel who would not willingly return to the war overseas, where men and women are kept alive by the close relational bonds connecting those who live, work and fight together and have a shared sense of life's meaning.  Society, however, often defines meaning in wholly different terms, into which some returning servicepersons no longer fit in the light of what they have experienced.   As a result they quickly feel unfit to be a part of the society they risk so much to defend. 

 Sadly, where some servicepersons they believe they DO "fit" is in deep, black emotional chasms into which warriors fall soon after they return to a life that is full of material comforts, but bereft of meaning.

 No private weapons ban will instill the will to live in warriors whose lives have been stripped of meaning.  Stripping them of weapons will only encourage them to look for other available exits from life. 

 Better that our military and our entire society focus our attention less on the false comforts of quick fixes, and more on providing empathic care, rendered shoulder to shoulder and face to face.  The hope that defuses suicidality is not found in a military "no weapons" order, but in the eyes of  other human beings who truly care.


Rev. Dr. Chrys L. Parker is co-author, along with Harry Croft, M.D., of the book I Always Sit with My Back to The Wall. She is a clinical chaplain, pastoral counselor and trauma therapist who has provided care for over 2,500 traumatized persons.  Harry Croft M.D. is a former Army doctor and psychiatrist who has evaluated more than 7,000 veterans with PTSD.  Visit www.mybacktothewall.com




Monday, September 24, 2012

Warrior Regatta & Veteran Golf Event - Days to Remember!


Greetings!

There are thousands of events nationwide that are raising awareness of the lives of our returning warriors, veterans, and their families.  There’s something very special about being outdoors, being treated “normally”, and enjoying the camaraderie of your peers that does a heart (and mind!) good.  Here are a few words about two events close to our hearts.

At the recent Wounded Warrior Regatta in Annapolis, Boeing sponsored a (surprisingly blustery!) day on the Bay in specially rigged sailboats designed for various disabilities.  The US Naval Academy Sailing Team coached the participants and many activities were planned for the entire group, including special activities for Caregivers, children, and friends. We were proud to provide time and awards to the group. This event was attended by elite Navy leadership which added accessibility to sharing warrior issues -- indeed a bonus for warrior families. Those that participated learned that sailing is both a physical joy and a mental game, very competitive, and you just plain feel good after a day on the water! 


On Friday, Blue Star Families held their First Annual Golf Tournament, and another fantastic fall day lent itself to a group of over 40 veterans.  As a partner with Blue Star Families, VeteranCaregiver volunteered time and gift awards to the event. BSF Leadership is very aware of the importance of family and highlighted their many programs (Books for Bases, Blue Star Museums, and more) to again raise awareness of the continuing value and contributions of veterans as they reside in communities across the nation.  As always, a host of volunteers is needed to attend to the many details, and this event was a real joy to all participants!


If you’d like to share your local event with us, please send me an email at info@wisehealth.com.  What works best for you and your vet?  Would you like to do events together as vet/caregiver, or separately?  Inquiring minds…  Enjoy your week!

Linda & the VeteranCaregiver Team