#170 Suicide Crisis Intervention The First 48 Hours
Introduction
This paper will focus on crisis intervention in the first 48 hours after a suicide of a member of the military. Particurally how the suicide affects the friends of the person who completed suicide. The background information such as statistics, and symptoms of a crisis will be considered. While special attention will be given to the issues that first responders face in responding to this sort of crisis. The religious and cultural issues will also be covered with attention given to the Biblical examples of suicidal ideation. The best practices of crisis intervention will be considered and applied to the military context. Then ideas for future research will be considered.
The Importance of This Topic
Suicide is alarmingly common in the United States and especially in the United States Military. According to some estimates the suicide rate in the Military is over 12%. In the face of this reality those who are in the position to care for military members and their families in the aftermath of a suicide must be prepared for the very real possibility of suicide. For those who care for military members the question of suicide is not if but when a suicide happens. Therefore having a plan in place for how to help the friends and family of those who complete suicide is essential. To not be prepared for this all too common occurrence would be negligence. Furthermore by being prepared crisis responders may prevent future suicides. It may be noted that “soldiers are nearly nine times more likely to die by suicide than they are in combat.” Suicide then is the most challenging adversary that the United States military faces today. In the aftermath of a suicide there is much work to be done to prevent future suicides. The phenominon of contagion suicide is not unknown to the military. When one person of a group commits suicide the rest of the group may consider it a viable opinion in the face of their grief. The question becomes how might a crisis interventionist identify those at risk and how can a crisis interventionist minimize the suffering of those at risk. Put another way “Soldier suicide is the exhaust pipe of America’s military machine on the move.”
Background Information
Suicide is often a lack of hope and if an individual lacks hope then this implies that the entire community likely lacks hope. When one suicide occurs it implies a broad lack of hope in the community or at least in the group that the suicidee was a part of. As Adams puts it suicide is mainly completed by people who “are predominantly persons with no hope.” Furthermore, “Most Service members who died by suicide were young, enlisted men.” Younger enlisted soldiers experience harsh working conditions, low pay, and often are completely removed from their support system. Being subject to frequent moves and having no immediate family. It may be noted that “In CY 2023, 523 Service members died by suicide. ”
Scope of Paper
The scope of this paper is limited to the impact of suicide on their fellow soldiers in the immedate aftermath of a suicide. With a focus on the first forty-eight hours. How to identify those in crisis from the suicide, how to respond to their grief, and reconnecting them to a support system. Soldiers tend “to feel a deep sense of responsibility and accountability for what he sees around him. It is as though every enemy dead is a human being he has killed, and every friendly dead is a comrade for whom he was responsible.” It is for those whose conscience is burdens by their fellow’s suicide and crisis interventionist that will help them that this paper is written.
Observations After a Crisis
Symptoms of Crisis After a Suicide
Oftentimes in the context of a suicide at a military base the crisis responder will have a familiarity with the person who committed suicide and their friends but when this is not the case the crisis responder must have a plan to identify those in crisis. People experiencing a crisis may become more standoffish, hyperalert, talkative, or quiet. While there are many different signs to watchout for, most of the relationship dynamics may be understood to be antisocial behaviors that are abnormal for the person in question.
Mental Health Issues
Mental health issues are not readily discussed in the military. While some people may self report issues related to the suicide of a fellow soldier this cannot be relied on as the sole means of providing support. Those in crisis need to be sought out. Identifying these individuals could be somewhat straightforward but many may fall through the cracks. By finding out who the roommates of the soldier were, coworkers, and who they dined with regularly the crisis interventionist may identify who needs support. The issues that arise will likely be related to grief. But other emotions like anger and questioning God may laso come up. Grief can manifest itself in many forms but the most likely form is a loss of hope due to their world being upended.
Common Relationship Issues
Soldiers generally form strong bonds which can become frayed when an individual commits suicide. It erodes trust in the entire group, not just the individual that was lost. Soldiers may turn inwards and become unwilling to rely on their former relationships making them become isolated. When the crisis interventionist sees this happening it is important to distinguish from normal vs abnormal antisocial behavior. While working with someone in a crisis, “it’s important to determine how well they were functioning prior to the crisis event.”
The BASIC Assessment
The BASIC assessment from Wright can help to filter individuals and assess what sort of crisis they are experiencing. The crisis responder will observe the Behavior Patterns of the individuals around the suicide and look for those whose behavior is out of place. It may be observed that a soldier is choosing to eat alone instead of in a group, or that a talkative soldier is now quiet. As individuals are identified the Affective Functioning will be questioned. The soldier may have abnormally strong or weak emotions about an issue in their world. Next is Physical Symptoms will be sought out. This can manifest itself in many ways from a rash or a change in weight. Then considering the whole environment of the individual in question Interpersonal. Do they have a support system? Has this loss caused them to disconnect from their support system? Finally the Cognition will be checked, where is their mind during this time (Wright 2011, 153). Are they focused on the past or future, searching for the reason behind the suicide, or considering suicide themselves. By assessing each of these areas the crisis responder gets a broader understanding of the issues in play.
First Responders
First responders or crisis interventionists are much like medical first responders. Their job is to assess damage and to stabilize the situation so that further attention and care can be given as needed. In the context of a military suicide the first responder may be one of the first people on the scene. They will make themselves available to those affected by the crisis and will search out those in crisis. In the immediate aftermath of a suicidal crisis the crisis interventionist will care for the people affected by the suicide so that the rest of the crisis team can do their job. Such as moving a roommate out of the crime scene so that the military police and emergency medical team can assess the situation.
First Responders and The Military
First responders who discover a suicide must work within a different set of systems and expectations than those outside the military. When a soldier commits suicide it may be military police raather than city police that do the investigation. Within the military context the first responder to the crisis will likely be a part of the military. Depending on the context of the crisis, this may be a chaplain, a medical technician, or a psychological counselor. In the context of a military base there will likely be all three types of people responding to the crisis and it may be three teams not just individuals. The chaplain is generally the best equipped person to respond to this crisis as they work with the soldier population and likely knew the person who completed suicide and their friends. This also means the first responder is at risk of crisis as well due to the familiarity and proximity to the crisis.
Special Training
More training is always good especially for those who deal with crises. Generalized training on crisis intervention would be useful. For this specific crisis training on why suicide happens, how to prevent it, and what to do in the aftermath of suicide are all essential to learn. A resource that is useful in this context is the Suicide Pair training program by Light University. The Suicide Pair program covers a wide variety of topics related to suicide and how to deal with them. As such it may be an essential source of knowledge for the first responder to a crisis like this. This training is particularly applicable to Christians who might respond to this crisis as the program is built around Christian theology. Giving the first responder information about how to provide hope to the hopeless Christian or not.
Personal Issues of Crisis Responders
Those who respond to crises are continually experiencing the trauma and crises of others. Over time this may cause the crisis interventionist to have a crisis of their own. Crisis interventionists must make time to process the information they receive. This may be done through a friend, counselor, or by journaling. Interventionists need to get “exact information and precise details are always important in a suicidal crisis so that an appropriate intervention can be shaped from the information.” This leads the interventionist to receiving all of the details of a crisis even the ones that may haunt their dreams. It is noted that “The turn toward suicide hinges on lack of hope.” First responders may become quite aware of all the ways that there is a lack of hope to be had. Therefore they must find a source of hope for themselves that is more meaningful than the trauma that they observe. The Christian first responder finds this hope in God while the non-religious first responder is left in a precarious situation. First responders do not necessarily need to provide hope to their clients but it is helpful to do so where possible while the client processes the loss. The first responder needs to have hope that can be shared in some way with those in crisis. Crisis responders must be constantly aware of what emotions they display. A wrongly placed smile or frown may erode trust in the first responder.
Best Practices in Crisis Intervention
There are many best practices in crisis intervention. One of the most poignant principles is that the one providing crisis intervention is not acting as counselor. The objectives and methods are somewhat different. While a counselor is focused on an individual's growth over the long term. A crisis interventionist is focused on the first two-three days following a crisis. If Worden’s four stages of grief are applied two distinct pictures take form. Worden’s four tasks include accepting the reality of loss (task 1), to process the grief (task 2), adjusting to the world (task 3), and building an enduring connection with the deceased (task 4) (Our House Grief Support Center 2025). The counselor might help an individual go through all four of these steps. Whereas the crisis interventionist is mainly focused on task 1 and task 3. The crisis interventionist is focused on making the client’s world okay even if they are not.
The crisis interventionist focuses on the individual and their relation to the crisis as well as their support structures. When an individual is experiencing a crisis this can quickly snowball into multiple related crises. Furthermore, the crises have a tendency to upend normal support structures. The crisis interventionist is focused on repairing or replacing those supports so that the other tasks of grief can be processed in a safer environment. For the crisis interventionist this means knowing the resources available to someone in this crisis and quickly getting them connected.
Application of Best Practices
When someone completes suicide in the military it affects a lot of people. Soldiers often live, work, and rest with the same people, forging tight bonds. When one soldier completes suicide the other soldiers do not simply lose a friend. They may also be losing a coworker, roommate, and workout partner. On top of this when one soldier completes suicide it may cause all the soldiers ot feel weaker or more exposed to loss. If they can commit suicide maybe you can too. Thus soldier suicide affects friends potentially more like the death of a sibling than simply that of a friend or coworker.
Since the potential for suicide “is directly related to losing hope in one’s circumstances, especially when the individual has a chronic sense of low effectiveness in mastering life” The Crisis interventionist must began the process of providing hope to those affected by suicide so that the contagion does not spread. This may take place in a variety of ways. It may include connecting to maps of meaning such as religion, connecting them to a grief group like Grief Share, connecting them to a counselor, exploring their support system, or simply providing an opportunity to exercise their grief in a healthy manner.
The first priority of a crisis interventionist in the aftermath of a suicide is to identify those affected, to ensure they are not suicidal, and then connect them to a support system. Crisis interventionists must “Take all ideas about suicide seriously.” If the crisis interventionist can identify how an individual justified their suicide it may give them insight into the potential crisises that others affected by the suicide might encounter. For example “For some it may include the loss of a “support system” or “emotional safety” that occurs when they move to a new environment.” If this were the case the interventionist might infer that a strong community is not in place and that other soldiers likely feel a similar sense of disconnection.
Religious Support Systems
When someone completes suicide it affects everyone in their lives in one way or another. When an individual is experiencing grief because of the suicide connecting them to a spiritual support system may be the best way to help them. People create meaning in their lives and a lens through which they understand what happens through religion. By tapping into this resource crisis interventionists give hope and provide meaning that may lessen the depth of crisis experienced. While also decreasing their risk factors by about 20%.
Biblical Examples of Suicidal Ideation
When taken from the Christian perspective there are many examples of suicide, hope, and grief. This provides the Christian crisis interventionist with many examples of crises and methods to deal with them. The example of Job and Jeremiah are most relevant and will be considered below but there are many other examples of suicidal ideation in the Bible. Other suicides or suicidal ideations in the Bible are Saul and his armor bearer in 1 Samuel 31:4-5, Ahithophel in 2 Samuel 17:23, and Zimri in 1 Kings 16:18. While in the New Testament the example of Judas Iscariot in Matthew 27:5 is not to be forgotten. Even respected Biblical leaders had moments of suicidal ideation such as Elijah in 1 Kings 19:4, Jonah in Jonah 4:3, and Moses in Numbers 11:14-15.
The example of Job
One of the best Biblical examples is that of Job. Job experienced several compound crises and was counseled by his wife and three friends. Except the counsel of Job’s friends and wife was not very helpful. By the end of the book of Job God becomes his counselor and shifts his perspective on his crisis leading him back to a normal life. Job experienced several reasons that death could become preferable to life such as “the demands of his life,” “unrelenting pain,” and “having nowhere to turn.” It was not until Job stopped focusing on his own suffering and instead focused on God’s glory that meaning came into his life and his grief turned into hope Job 42:5-6a says, “I have heard of You by the hearing of the ear; But now my eye sees You; Therefore I retract, And I repent.”
The Example of Jeremiah
Another poignant example of a Biblical character who wished for death was Jerimiah. Jeremiah “wanted to die because he was constantly in a sorrowful mode” as it says in Jerimiah 20:18 he asked why was I born, “to look on trouble and sorrow, So that my days have been spent in shame?” Shame then is one of the Biblical explanations for suicidal ideation. Shame and grief are in many ways the inverse of the hope that is found in God. Bible characters like Jeremiah did not see a way out of their shame. Yet they find hope in God when they place their trust not in themselves or their experience but instead in God as it says in Psalm 119:116, “Sustain me according to Your word, that I may live; And do not let me be ashamed of my hope.”
Using Biblical Examples
Biblical examples of suicide can serve many purposes for the crisis responder. They can be used to give a voice to the deceased helping others understand the loss. It may also help the surviving soldiers who are now feeling suicidal understand the Biblical dimensions of their issue. Most importantly it reminds people that hope is found first and foremost in God. When individuals are reminded why they have hope the effects of grief may not be lessened but their effects can be dulled.
Cultural Considerations
Another dimension to consider when working with those affected by suicide is their cultural background. The cultural background of an individual can provide clues about their thought process and how they might respond to their loss. For some people the suicide of someone from a similar background as them may cause them to question their beliefs or behaviors. For others it may cause the reason for their own suffering to become clear (Talbot 2016, 34). As difficult as their experience might be, it can bring insight.
As challenging as it might be, grief and pain are part of God’s plan. Through the Bible “we are taught to pour out our complaint, sorrow, and anguish to the God in whose presence we not only live but also suffer.” This may take on different forms depending on the cultural background. For one person this may mean turning inwards and isolating while for another it means reconnecting with their community. When a crisis interventionist is aware of the culture differences in play they can distinguish from a normal grief response and one that is the precursor to another crisis.
Uncertainty Avoidance
Culture plays a role in a crisis particularly through uncertainty avoidance “Uncertainty avoidance has to do with the degree to which cultures feel threatened by uncertainty and ambiguous situations, so rules, procedures, rituals, and laws may be formulated to buffer uncertainties of individual judgment.” For the crisis interventionist this means when entering a new environment learning how that culture goes about surviving. As each culture has different standards of conduct and those do not necessarily match those of the crisis worker. In the military there is generally a high uncertainty avoidance which is a result of training. Because of this uncertainty avoidance soldiers may avoid thinking about or dealing with the uncertainty that arises after a suicide.
Conclusion
When it comes to soldiers experiencing the crisis of a fellow soldier commiting suicide many factors are at play. It has been noted that suicide is more common in the military than in the general population. It would seem that suicide is often the result of challenging high stress environments. That the surviving soldiers may to be at risk of suicide because of the same risk factors that may be part of the original suicide. It has been discussed how religion and culture play a role in how people process grief. While considering how a Christian crisis interventionist might respond to to suicide using the stories in the Bible to create maps of meaning for Christian soldiers. It has also been considered how best crisis interventionists may help soldiers experiencing crisis. Throughout this paper it has been noted how grief and hope are deeply intertwined.
Ideas for Future Research
Future research on this topic could help to more fully understand the issues in question and ways to respond to them. Real life examples of suicide in the military and how crisis interventionists were able to help soldiers could be considered and compared. Furthermore, more research into the groups that are more prone to suicide and the reasons behind it could be explored. Another topic would be to consider the different types of support systems, their perceived value, and effectiveness in preventing suicide and other crises. Despite suicide being the one of the leading causes of death in the military resources to help those involved in the prevention and aftermath of suicide are few and far between. A playbook for the crisis interventionist in the military outlining who should do what would be especially helpful in making sure everyone is connected.
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