Decisive Point Podcast – Ep 3-45 – MAJ Thomas H. Nassif and CPT George A. Mesias – Leader Perspectives on Managing Suicide-related Events in Garrison

Leaders who have personally experienced the aftermath of a suicide-related event can provide important lessons and recommendations for military leadership and policymakers. This podcast executes a thematic analysis of interviews with leaders, chaplains, and behavioral health providers who responded to garrison suicide-related events and explores leader decision-making related to memorials, investigations, and readiness

Keywords: garrison, chaplain, behavioral, military leader, suicide postvention, health provider

Read the article: https://press.armywarcollege.edu/parameters/vol52/iss4/14/

Episode Transcript: Leader Perspectives on Managing Suicide-related Events in Garrison

Stephanie Crider (Host)

You’re listening to Decisive Point, a US Army War College Press production focused on national security affairs.

The views and opinions expressed in this podcast are those of the authors and are not necessarily those of the Department of the Army, the US Army War College, or any other agency of the US government.

Decisive Point Welcomes Major Thomas H. Nassif and Captain George a Mesias, co-authors of “Leader Perspectives on Managing Suicide-related Events in Garrison” with Dr. Amy Adler. This article was featured in the Parameters Winter 2022–23 edition.

Nassif, a research psychologist at the Walter Reed Army Institute of Research (WRAIR), serves as the Institute’s lead on mindfulness training research efforts with the US Army War College and the US Army Training and Doctrine Command. He’s also the principal investigator on a military suicide research grant funded by the congressionally directed medical research programs.

Mesias is a licensed clinical social worker and researcher at WRAIR. He’s advised commands and planned behavioral health operations across the Korean theater of operation and served as behavioral health officer for a Stryker Brigade. He is an Applied Suicide Intervention Skills Training master trainer and a graduate of the Army Social Work Child and Family Fellowship Program.

Dr. Amy B. Adler is a clinical research psychologist and senior scientist at the Center for Military Psychiatry and Neuroscience at WRAIR. She’s had numerous randomized trials with Army units, published more than 180 journal articles and chapters, and served as lead editor of Deployment Psychology and Anger at Work, both published by the American Psychological Association.

Your article opens with, “In the last decade, suicide has become a leading cause of death for service members, claiming more lives than combat and transportation accidents.” This is a hard topic to ease into. What else do we need to know about service members and suicide for this article?

MAJ Thomas H. Nassif

Suicide is a difficult topic for a number of reasons. And many, if not all of us have been touched by it in some way, and the ripple effects across the unit and community when there’s a suicide-related event. It’s a really important topic, and there are many initiatives that the Army is engaged in that address risk factors and prevention.

Our paper tackles a different part of the problem. you probably heard of prevention. What we’re going to talk about today is postvention, in other words, what leaders do in the aftermath of a suicide-related event.

First some terminology. So we define a suicide-related event as death by suicide, suicide attempt, or suicide intent. And by leader, we’re referring to chaplains, behavior health providers, and unit leaders. And the leaders that we focused on in the article were chaplains, behavior health providers, and unit leaders.

Although postvention has been studied in a deployed setting, we focused on garrison settings, which run the risk of being overlooked.

CPT George A. Mesias

This is Captain Mesias. I’m a licensed clinical social worker. As a social worker, I’ve served as a therapist for soldiers, and I’ve served as a behavioral health officer for a Brigade combat team. Suicide is an often-discussed topic due to ACE training requirements that everybody has every year, but I’ve seen how different it is to be exposed to suicide directly. Experiences with suicide leave a lasting impression, and I’ve spoken to many people who’ve shared as much. And I’ve felt that way, as well. So, I was happy to be part of this manuscript because I feel like those experiences often aren’t shared enough.

Host

Your piece reports some results from a thematic analysis of interviews with leaders, chaplains, and behavioral health providers, and you touched on several points. I’d like to walk through them briefly, please.

Nassif

We interviewed more than a dozen chaplains, behavioral health providers, and unit leaders. And each of them had dealt with a suicide-related event in the previous five years. These were individual, semi-structured interviews. And we wanted to hear from these leaders what the experience was like for them—where they struggled, and what advice they had for others. We were not only interested in what leaders did in the aftermath of a suicide-related event, but also how it affected them. Our article also sought to illustrate real-world experiences that might be useful for leaders who may have to manage a suicide-related event in their unit.

Host

Let’s just start with one of the first things listed in the article. Confronting personal emotions about suicide—what do we need to know?

Nassif

Well, by recognizing rather than avoiding personal emotions in response to a suicide-related event, leaders appear better able to respond effectively. And additionally, leaders in our study reported that engaging in productive coping strategies, such as connecting with family for support or partaking in enjoyable activities outside of work, were useful.

Host

What do we need to know about managing stress around blame?

Mesias

Well, a lot of leaders discussed this. Whether it’s being blamed by family members for the death of a loved one or experiencing the strain of required investigations, and important ones as well. I mean, investigations are administratively just part of the process. But leaders often find themselves juggling blame attribution as an additional source of stress during a difficult time. Furthermore, while those affected by suicide may seek answers as to why it occurred, it’s not always possible to identify a root cause. Very often not. It’s a lot of factors and just . . . there’s no easy answers.

Host

One of your other themes was caring for individual soldiers and sustaining unit readiness.

Nassif

Well, the health of an organization’s climate and culture begins with the leader’s commitment to being visible to, open with, and compassionate toward soldiers. So, by striking a balance between empathy and discipline, leaders can both support the needs of individual soldiers and maintain unit morale. Striking this balance was difficult for leaders, as they remarked in the interviews, but many felt this was an essential aspect of successful leadership.

Host

You also addressed leveraging communication channels.

Mesias

Well, this is important because the leader can’t be everywhere at once. Chaplains and behavioral health providers can support leaders’ efforts in fostering open communication channels before, and definitely following, a suicide. In addition, empowering subordinate leaders to monitor their soldiers and keep an eye on them for potential behavioral health concerns or just life problems that can pose a challenge. This can help leaders identify unit members in need of additional support both before and, definitely after, a suicide-related event. There’s also risk reduction tools to help identify and support soldiers, but keeping dialogue open and relationships is key.

Host

You also talked about planning the postvention response. Would you address that for us?

Nassif

So, through the interviews, leaders reflected on their past experiences with postvention. And they offered a number of actionable strategies that could be provided during the postvention process, such as normalizing help-seeking behavior, offering a variety of behavioral health services, coordinating suicide awareness, and prevention training events. And collectively, these actions were aimed at reducing the risk of additional suicide-related events and also establishing a culture that proactively supports the behavioral health of unit members.

Host

You also addressed building a supportive climate to reintegrate at-risk soldiers.

Nassif

Determining what actions to take to support our soldiers can be very difficult, and leaders may find certain tools helpful to assess risk factors in their unit. One example that we talked about in the article was the Leader’s Suicide Risk Assessment Tool. By assessing risk factors, leaders can monitor their units viable health, foster a sense of unit connection, strengthen camaraderie, and take proactive actions to build a safe and supportive climate. And in some (cases), these actions can help leaders successfully reintegrate the soldiers in their unit.

Host

Honoring the life of the soldier, not the suicidal act.

Mesias

So, leaders talked about wanting to be careful in planning memorial ceremonies to recognize the life and the service of the soldier rather than focus on the suicidal act. And this is so that memorial services can support unit members, family, and friends in the coping process . . . provide a sense of closure for those affected by the suicide, but also discourage future suicide-related events.

Host

How can leaders put this information to good use?

Nassif

Leaders, chaplains, and behavioral health providers should build strong relationships and frequently interact with each other. They should also prepare for worst-case scenarios by discussing how would they respond to a suicide-related event and work as a team. Also leader training on suicide postvention could incorporate frank discussions on personal feelings and biases regarding suicide, including how much time is needed to mourn, when should military training resume, how do we handle memorial services, and how can we best manage attitudes about blame and ways to engage in self-care? And this includes subordinate leaders and just up and down the chain of command. Another recommendation would be to prepare leaders to be adaptive, tuned, and responsive to unit members and foster a nonjudgmental culture in the aftermath of a suicide. Related event.

Mesias

We also discussed how leaders may benefit from having mentorship support from senior leaders who’ve been through this themselves. Mentors can help validate the challenges of postvention and provide practical guidance to leaders following a suicide in their unit. They can also provide a level of understanding and emotional support. So many gray areas exist in the suicide postvention decision-making process, and leaders can choose from a number of strategies to mitigate potentially negative impact on themselves, their unit, and the wider community. Not every suicide is the same. So we’re trying to explore some of those gray areas and the challenges that leaders may face that they hadn’t expected.

Host

Give us your your. Final thoughts on the topic please.

Nassif

Our goal is to provide leaders, useful perspectives and support so that they can respond appropriately and work through the psychological challenges (that come with suicide-related events). And, you know, there are toolkits available to further support leaders through the postvention process. One of them is the Defense Suicide Prevention Office toolkit, the Postvention Toolkit. It’s really valuable. This resource provides additional perspective on postvention with guidance and recommendations.

One thing that struck us from the interviews was the way in which leaders were able to take tactical pause to assess the situation and adapt with novel responses to help guide their unit through postvention.

I’ll share a few examples from our article.

One leader realized that timing was critical in the aftermath of a suicide, but moving from a period of mourning to refocusing on training had to be carefully timed. So this particular leader decided to shift training a week later to build an additional time for mourning, which ended up helping unit morale. And by reengaging unit tasks, he was still able to maintain unit discipline.

Other leaders came up with creative ways to work within the constraints of chaplain confidentiality to keep communication channels open. One leader asked their chaplain to provide weekly anonymous stats to the command on the overall health of the unit, such as marital problems, suicidal ideations. By reporting the number of suicidal ideations each month, this provided the leader a useful way of highlighting the overall risk facing the unit while also maintaining confidentiality.

And in one last example, another leader responded to a suicide in his unit by generating positive messaging up and down the chain of command to normalize help-seeking behavior as an act of strength and courage rather than a sign of weakness. And it was a way to not only emphasize the physical health but also mental wellness to soldiers in the unit.

And I just wanted to close by saying that we’re really grateful for those who participated in the interviews and spoke so candidly with us. This is still an evolving topic, and we’re learning more about it all the time. Suicide-related events have ripple effects. We hope that our paper offers some support to leaders moving forward. We’d like to thank the Military Operational Medicine Research Program for funding this study, Dr. Amy Adler, our senior science consultant and author on the manuscript, for conceptualizing this qualitative study on postvention, and CPT Mesias for his expertise as a licensed care social worker for providing that expertise. We’d like to think WRAIR. We want to also thank the Army War College for taking an interest in our article and also giving us the opportunity to speak on this podcast.

Host

What a pleasure to have you and to have you included in Parameters. We’re glad to provide a platform for this conversation. Thank you so much, both of you for sharing your insight on this important topic today.

Mesias

Thank you.

Host

Thank you if you’re interested in learning more about this topic, read the article at press.armywarcollege.edu/parameters. Look for volume 52, issue 4. If you enjoyed this episode of Decisive Point and would like to hear more, you can find us on any major podcast platform.

Author information:

Major Thomas H. Nassif, a research psychologist at the Walter Reed Army Institute of Research (WRAIR), serves as the WRAIR lead on mindfulness training research efforts with the US Army War College and the US Army Training and Doctrine Command. He is also principal investigator on a military suicide research grant funded by the Congressionally Directed Medical Research Programs.

Captain George A. Mesias is a licensed clinical social worker and researcher at WRAIR. He has advised commands and planned behavioral health operations across the Korean theater of operation and served as a behavioral health officer for a Stryker brigade. He is an Applied Suicide Intervention Skills Training master trainer and a graduate of the Army Social Work Child and Family Fellowship Program.

Dr. Amy B. Adler is a clinical research psychologist and senior scientist at the Center for Military Psychiatry and Neuroscience at WRAIR. She has led numerous randomized trials with Army units, published more than 180 journal articles and chapters, and served as lead editor of Deployment Psychology and Anger at Work, both published by the American Psychological Association.