Suicide And Homicide Risk Management (Page 3 of 18) in pdf

Suicide and Homicide Risk Management

Though often useful, unit watch may not always

tions involved alcohol or drug use.

Such substance

be the best approach. The treating mental health

use may impair judgment and lower inhibitions

professional uses clinical judgment to determine the

against acting on suicidal or homicidal impulses. A

best course of action. One factor to consider is that

properly executed unit watch ensures that soldiers at

a unit watch carries some risk of stigmatization by

risk are not given access to alcohol or drugs, thereby

peers. Fellow soldiers may become frustrated with

reducing risk. Also, by limiting contact with people

the soldier because of increased workload and poten-

who might exacerbate the soldier’s condition or be-

tially increased hazards as they attempt to cover the

come a victim of the soldier’s homicidal intent, a unit

soldier’s battlefield responsibilities or provide per-

watch may further reduce risk and prevent adverse

sonnel to monitor the soldier. This frustration may be

outcomes.

exacerbated if the soldiers experiencing suicidal and

Finally, the utilization of a unit watch for a soldier

homicidal thoughts, who often have a limited ability

who presents with “military-specific” suicidal or

to give and receive social support, have already mar-

homicidal ideation may be highly effective in reduc-

ginalized themselves. Many soldiers on unit watch

ing secondary gain, a term that describes the tangible

have described to healthcare professionals episodes

advantages and benefits that result from being sick.

of ridicule and verbal harassment by both peers and

The terms “military-specific suicidal ideation” and

leaders in their units. Regardless of the setting, stigma

“military-specific homicidal ideation” refer to the

associated with receiving mental healthcare can be

verbal expression of suicidal or homicidal thoughts

significant.

Adequate education of the unit leaders,

with the implicit (as determined by the clinician) or

who then train unit members to envision a unit watch

explicit goal of avoiding a military duty such as a

as analogous to “helping a family member in distress,”

field training exercise or deployment, of receiving a

may help alleviate some of the stigma.

transfer to another unit or occupational specialty, or of

Leadership, unit cohesion, and group identification

obtaining a separation from active duty. In such cases,

play decisive roles in a soldier’s ability to cope with

soldiers essentially imply or state that they may or will

peacetime or wartime duties. A unit watch may focus

kill themselves or a leader in their unit unless they are

the command team’s attention on issues or stressors

allowed to achieve the stated goal. Such statements

affecting their soldiers. In addressing these stressors,

are often accompanied by allegations of harassment

the command team may provide enhanced support

against the unit chain of command that may or may

to the soldier and may actually resolve some of the

not be well founded. In many cases of military-specific

issues that are contributing to the heightened suicide

suicidal or homicidal ideation, the soldier’s threats are

or homicide risk. Ideally, the command team will

directly linked to a desire to get out of the military.

consistently communicate the expectation that the

Such soldiers may believe that reporting suicidal or

unit watch is a team effort designed to help one of

homicidal thoughts is an easy way to “get chaptered”

their own and to enhance both unit cohesion and the

(seek honorable administrative discharge) without

soldier’s ability to contribute. Such support can reduce

negative consequences. In the absence of risk factors

the agitation and hopelessness often present in soldiers

requiring hospitalization, military-specific suicidal or

with suicidal or homicidal thoughts.

Working with

homicidal ideation is an indication for a unit watch,

4,10

a command to ensure a unit watch environment that

thus conserving inpatient treatment services for other

builds social support can be extremely helpful for the

service members who are more likely to benefit from

soldier. Strengthening such social support may play a

these services. Additionally, soldiers in the unit rapidly

key role in the soldier’s recovery.

develop an awareness that the mental health system

11,12

Although some risk remains, the authors contend

is not there primarily to provide an escape from du-

that unit watch significantly reduces the risk of a sol-

ties and responsibilities, but to provide supportive

dier accessing lethal means such as firearms, ropes,

treatment, helping them function more effectively in

medication, or knives. Of these weapons, firearms

a military environment.

deserve special mention. In 2004 and 2005, firearms

While useful in the management of military-specific

were the most common method of suicide completion

suicidal or homicidal ideation in garrison, unit watches

within the US Army (62% and 69%, respectively, per

in a theater of operations are even more valuable.

year).

By limiting access to firearms, a unit watch is

Military-specific suicidal and homicidal ideation are

13,14

likely to reduce the soldier’s risk of suicide completion

arguably two of the most common presenting behav-

early in the course of treatment, thus allowing time

ioral health symptoms on today’s battlefield and could

for the treatment and supportive interventions by the

easily develop into an evacuation syndrome if not

command to take effect.

managed appropriately.

A force that is well-versed

Among US Army soldiers attempting or completing

in unit watches from its garrison experience is much

suicide in 2005, 57% of attempts and 17% of comple-

more likely to successfully employ the intervention

425

Suicide And Homicide Risk Management Page 3

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