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Mayor's Challenge
September 19, 2018
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211 Explores Solutions in the 2018 Mayor’s Challenge to Decrease Veteran Suicide
 
This year, “The Mayor’s Challenge to Prevent Suicide Among Service Members, Veterans and their Families,” (Mayor’s Challenge) has brought together community, government, and service organizations to create opportunities for more collaboration, trainings, and community engagement so that veterans have better access to mental health and community support. 

On March 16 2018, the Substance Abuse and Mental Health Services Administration and the U.S. Department of Veterans Affairs sponsored a task force meeting in Washington D.C. for seven cities to develop their own interagency plan to “improve local suicide prevention efforts for veterans and their families.”

LA County’s team included but was not limited to Mayor Garcetti’s Crisis Response Team, the LA County Sheriff’s Department, Didi Hirsch Mental Health Center, 211 LA, LA County’s Veteran Administration, West LA’s VA Medical Center, and the Red Cross. 

They developed a seven-step action plan to carry this initiative out, based on the Seven CDC Strategies for Suicide Prevention and SAMHSA’s successful guidance model on enhancing service systems in behavioral health.  

On Friday, 211 LA Executive Director, Maribel Marin, introduced key collaborators Sharon Birman, Clinical Psychologist at the West LA VA Medical Center, Lisa Salazar, Director of Workforce and Economic Development for Mayor Eric Garcetti, and Sandri Kramer, Program Director at Didi Hirsch, to 211 LA’s headquarters to show them more about our operations, and identify areas their organizations can help to fill service gaps in the SMVF (Service Members, Veterans, & Family) support system. 

This challenge incorporates existing projects supporting veterans at risk of suicide, according to Marin. “We’re expanding and connecting what people have already been doing.”

“We’re targeting vets because of their high rate of suicide,” said Marin. 20 veterans commit suicide each day, and yet 14 of those veterans are not connected to support through the U.S. Department of Veterans Affairs.

This can be due to varying eligibility for different services, but it’s mostly because navigating the many levels of the VA is difficult and unappealing for many veterans. “How can we come together to tackle this from all these different angles?” posed Sandri Kramer.

Here are the seven steps in the Mayor's Challenge action plan and why they are important:

1. Strengthen access and delivery of behavioral health care
The first step in this plan is to distribute trainings on military culture to agencies that work most frequently with veterans, such as colleges, namely the USC Center for Innovation and Research on Veterans and Military Families, the LA Housing Authority, hospitals, and first responders. 

Identifying types of training needs, what areas and populations have the highest amount of need, and what support services already exist will inform the initiative on how to most effectively distribute these trainings. 

Birman also highlighted the importance of establishing roles between service providers and identifying one point of contact who will know everything about a client to fill any gaps in service. On the West LA VA Hospital campus, independent contractors are also trying to accomplish the same goals in the same space. However, clinical mental health care professionals may find themselves in the position of care coordinator, and case managers find themselves doing social work that they aren’t qualified to perform. 

“I have the experts in linkage, and triage, and management of different services. Between these contractors that are on our grounds, and you guys [211] being the experts, I just wonder if there is a role,” said Birman. 

2. Create protective environments through smoother means restriction
Further counseling is also needed on effective means restriction, which is an important component to suicide prevention. A specific and careful approach must be taken to take away the gun of a veteran who is suicidal. They plan to provide training for lethal means counseling to encourage voluntary surrender of a firearm, even temporarily, before legal action is taken by force.

“We must find way to keep firearms safe, to take firearms away from a veteran, and how to convince a veteran to give up their weapon before they break down the door,” said Sharon Birman.

3. Promoting Connectedness Through the Mayor’s Crisis Response Team (CRT) & Peer Support Programs
Finding veterans who are service providers who work with other vets also helps bridge the gap in culture and experience that they usually experience with civilians.
 
“They respond better when they find out you’re a vet. If you don’t know the lingo, then you’ve lost them. It’s difficult having civilians tell you what to do. They don’t want to be pampered, they want to be treated with Image with text describing veteran culturerespect,” said MET Team Sherriff Deputy, Joe Miranda.

In February 2018, the LA County Board of Supervisors approved a large veteran peer support network across LA County by Volunteers of America. These peer veterans would be embedded in the Mayor’s Crisis Response Team, which assists the LAPD in meeting needs of all crisis situations. 

Additionally, veterans could make more informal connections through the peer network  to help overcome the stress and bureaucracy that drives many veterans from seeking help from the VA. 
 While peers play an integral role in bridging the veteran to civilian gap, they also need technical and emotional support from other mental health professionals.
 
“We see a lot of need to support those peers in a very structured way, in terms of somebody overseeing the work that’s either being transmitted to them as a care plan, or instructions on what a client needs,” said Marin.

Lisa Salazar, the Director of Workforce and Economic Opportunities for Mayor Eric Garcetti, highlighted the need for each player to understand all of the services that are currently open and available to veterans.

“We need to have good understanding of the processes and structures, so we have the language and verbiage to speak to it,” said Sharon Birman. 

4. Teaching Coping and Problem-Solving Skills Through Training and Evidence-Based Interventions
This step would train medical and behavioral health providers on safety planning and suicide counseling. 

5. Identifying and Supporting People at Risk Through the Mayor’s “Just Ask” Campaign
This portion of the Mayor’s Challenge Plan will primarily be using the Columbia Severity Rating Scale to assess risk. 

“We’re looking at using the screener version of this C-SSRS widespread throughout LA County so that all of us in our various roles can use it and it’s very simple,” said Sandri Kramer in her presentation at the Summit on Suicide Prevention.

This step also requires comprehensive data on suicide to be gathered from organizations like LAHSA, the VA, DMV, DMH, and the Department of Public Health. The LA Team has since requested $5,000 in grant funding from the California Mental Health Services Authority. “We need funding to collect data,” said Kramer.

6. Lessening harms and Preventing Future Risk: Creating a suicide safer community by learning from survivors how to recognize and intervene before it’s too late. 
The best way to know how to identify and help those struggling with suicide is to speak to the people who have overcome it. Birman and Kramer are therefore working on creating a Survivors of Suicide Attempts (SOSA) group within the Department of Veterans Affairs. They also plan to distribute ASIST, or Applied Suicide Intervention Skills Training, to the National Guard, Medical Board Examiners, and the Community Veteran Engagement Board so that they know how to recognize signs of suicidal thoughts in others, reach out, and help them create a plan out of harm’s way. 

7.Strengthening Economic Supports: Creating opportunities to support and employ veterans who are transitioning or unemployed.
A lot of depression comes from financial insecurity and not having a sense of purpose through an occupation. There are almost 4,000 homeless veterans in LA County, according to LAHSA’s 2018 homeless count.  Through potential connections with the Veteran Supportive Employment Program, the Soldier’s Project, and the Veterans Collaborative employers group, Lisa Salazar hopes to provide more employment resources to direct veterans to. 

For having served and fought for the United States in the name of freedom and safety for its citizens, this coalition recognizes the obligation to support and serve our troops when they come back to the U.S. and must re-adjust to civilian life. While not all veterans have PTSD or are homeless or suicidal, veterans deserve more specialized and comprehensive support so that no veteran is left behind.   

“That’s why the community has to be engaged. We’re really preparing the entire community to respond to suicide generally,” said Marin.