NMCRS visiting nurses role play to learn how to deal with various scenarios as part of suicide prevention training.

No matter how many times it’s happened, “one of the most terrifying things is to answer the phone or read a text from someone who says, ‘I’ve got a loaded weapon in my hand and you need to give me a reason to live,’” explained NMCRS Director of Nursing, Tammy Ackiss. Twenty American veterans die from suicide each day, according to the VA. Veterans are more than 20% more likely to attempt suicide than the general population.

This tragic statistic, and the experiences of many NMCRS visiting nurses, is the reason why the Society felt the need to provide suicide prevention training for all NMCRS visiting nurses – those who support combat-served Marines, Sailors, and their caregivers; and those supporting mothers with newborns, elderly retirees, and widows. “Our combat-served client population has a higher risk of suicide due to post-traumatic stress (PTS), traumatic brain injury (TBI), or simply depression related to their own physical or emotional losses – or the loss of someone they cared about,” said Ackiss. “Our visiting nurses deal with suicidal ideation frequently. We knew we needed to equip them with the training and tools to respond appropriately.”

While suicidal thoughts or actions may be more common among combat-served veterans, our traditional visiting nurses must also be vigilant about the warning signs of suicide, especially among new moms suffering from post-partum depression. “Currently, one of our visiting nurses is working with a service member and his family. His wife’s post-partum depression went undiagnosed and she took her own life. Unfortunately, they didn’t know about the Society’s visiting nurse program until it was too late. We don’t want that to happen again.”

We approached USAA Bank, one of our corporate alliances, and requested a grant for Society visiting nurses to attend Applied Suicide Intervention Skills Training (ASIST). This year, all 52 Society visiting nurses participated in a two-day interactive ASIST workshop conducted by professional trainers with extensive experience in suicide prevention and counseling. Today, thanks to support from USAA Bank, we’re pleased to report that training has already been put to good use.

Within a month of attending the workshop, Society visiting nurse, Patty Kotora, noticed a Facebook post by one of her clients, a combat-served Marine. His message indicated that he was in crisis and planning to end his life. “I immediately telephoned the veteran – and he answered my call, thankfully. I asked him very directly if he was planning to harm himself. He said that he was. I would not have been as direct this early in our conversation without the knowledge and skills I learned through the ASIST workshop,” she explained.

While Kotora continued to converse with the veteran, she used another phone to text a colleague back in her office who was able to locate the client’s home address and call 911. Kotora kept talking to the distraught veteran while waiting for police and paramedics to arrive at his home. “Over the next 30 minutes, I learned that my client was suffering from acute physical pain, which was increasing his chronic emotional pain. He was feeling completely hopeless. As I listened to him share his feelings, I was careful not to offer alternatives or solutions that were beyond the immediate time frame – another skill I learned from the ASIST training. I encouraged him to keep talking to me, telling me about his feelings and about the people in his life who consistently supported and loved him. I looked for the ‘turning point’ in the conversation—any indication that he might consider an alternative to harming himself.”

A few weeks later, Kotora got a phone call from one of her clients about another Marine veteran with whom he had served. He was very sure his friend was in danger. Again, she immediately called the veteran – and he answered her call. He was in his car, driving through the city in a high-speed chase with the local police. The veteran told Kotora he had a gun and was planning to shoot himself, or drive his car into the ocean. Kotora learned he’d had an argument with his wife, and she was planning to leave him and take their son. She also learned that his medications had recently been changed causing him increased physical and emotional pain. “Several times, he became agitated and hung up, but he kept calling me back” recalled Kotora.

“I encouraged him to talk about his current medical symptoms, and about his young son,” she said. “I pointed out that his pain and inability to sleep were acute and, with proper medical care, he could get some relief. We talked about his son, and his concern about not having a future with his son. Again, this was the ‘turning point’ in the conversation. He’d already told me how much he wanted to be with his son, that he wanted to live but he needed relief from his emotional and physical pain. I repeated these statements back to him to validate that I was listening –another skill I learned from the ASIST training.”

Eventually, Kotora’s client pulled his car off the road, threw his weapon out the window, and surrendered. Because Kotora had been communicating with the police, the officers allowed him to surrender peacefully and Kotora was able to facilitate a quick transfer of her client from police custody to a mental health treatment center. “Prior to the ASIST training, I believe I would’ve handled this situation very differently. I probably would’ve delayed contacting 911 because I knew they were already engaged in this incident. Instead, I made the decision to call them so they could listen in on my client’s conversation with me. I believe that was a significant factor in his safety and surrender.”

Recently, an NMCRS office received a call from a young military wife. She told our volunteer that her husband was in the field training with his unit and she was “planning to drive her car into a tree.” Our volunteer caseworker kept the client on the phone, while the visiting nurse, Yani Dilag, called 911. The dispatcher immediately directed the local police to the client’s home. Dilag had been working with this military spouse and knew she had a history of PTS. The local police arrived, calmed the client, and took her to the nearby hospital where she received treatment. “I think this situation went like a drill,” said Dilag, “because I was prepared – thanks to the ASIST training made possible by USAA Bank.”

Making a difference and saving lives — thanks to donors like you.


By Betsy Rosenblatt Rosso


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NMCRS Legacy Blog

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