Annex D: CFAO 19-44 - Suicide Prevention (Issued 1996)

Purpose

1. The purpose of this CFAO is to describe the policy, responsibilities, measures and procedures for suicide prevention, intervention and post-intervention.

Related orders

2. This CFAO should be read in conjunction with and supplementary to:
   1. 4-13, Reporting of Significant Incidents;
   2. 22-4, Security and Military Police Services;
   3. 24-1, Casualties – Reporting and Administration;
   4. 24-2, Report on Injuries;
   5. 24-5, Funerals, Burials and Graves Registration;
   6. 24-6, Investigation of Injuries or Death;
   7. 34-40, Hospital Admissions and Discharges — Reporting;
   8. 34-55, Management of Critical Incident Stress in the Canadian Forces;
   9. 56-15, Canadian Forces Social Work Services; and
   10. QR&O 21.56, Investigation of Aircraft Accidents.

Definitions

3. In this order:
   • “attempted suicide” means unsuccessful suicide;
   • “intervention” means use of measures including confrontation, therapeutic consultation and hospitalization to effectively manage incidents of suicide and attempted suicide;
   • “post-intervention” means actions taken to reduce the trauma of the bereaved, as well as investigative and Critical Incident Stress Debriefing (CISD) activities to be undertaken following a suicide or attempted suicide;
   • “prevention” means use of measures such as education and awareness through information to reduce the prevalence or probability of suicidal behaviour;
   • “suicide” means intentional self-inflicted death.

General

4. In Canada, suicide is the fourth leading cause of death after motor vehicle accidents, cancers and cardiovascular diseases. While suicide occurs at all ages and rank levels, it is most common among younger Service personnel. Every suicide raises the question of whether the death could have been prevented. Moreover, suicide may lead to serious trauma and stress for bereaved family, friends and co-workers, and may induce suicidal thoughts and behaviour inothers.
5. Most cases of suicide are preceded by warning signs. Some of these, such as giving away treasured possessions or openly expressing suicidal thoughts or intentions, are closely linked to suicidal acts. Other indicators of risk, such as alcohol or substance abuse, and changes of behavioural patterns or depression, are not unique to suicide. Evidence of such warning signs should not be discounted in any individual. Instead, the appropriate interventive measures should be initiated to ensure that these people receive prompt attention.

Policy

6. The goals of the Canadian Forces (CF) suicide policy are to reduce the incidence of suicide and attempted suicide to the lowest possible level, and to provide an immediate means for assisting a member who has attempted suicide or, in the event of a suicide, to assist bereaved family members, friends and co-workers.

Prevention

7. Suicide is an extremely complex and individual act. The cause and signs are varied and often difficult to identify. Signs of emotional distress or depression can indicate the risk of suicide. It is the ability to recognize these signs and the knowledge of how to react that are fundamental to suicide prevention.
8. Awareness and education can enable CF members to recognize the danger signals and respond appropriately. Educational programmes may also make distressed members aware that help is available.
9. The Director Medical Services (DMS) is responsible for providing advice and assistance to all staffs involved in developing suicide awareness programmes. DMS, in conjunction with the Health Promotion Advisory Group (HPAG), and the Directorate of Individual Training (DIT), will coordinate educational programmes, as appropriate, aimed at enabling all CF members to recognize and respond to indications and signs of suicide.
10. Commanding officers (COs) are responsible to ensure that suicide prevention is given appropriate priority within the unit.

Intervention

11. Suicide intervention should begin when the signs of potential suicidal behaviour are first observed and identified in an individual. Signs and symptoms of potential suicide must be reported immediately to medical staff, or if unavailable, to a social work officer (SWO) or chaplain, who shall initiate such action as is required.
12. Base commanders and COs are to develop appropriate intervention plans to allow a rapid, coordinated and effective response to reports that an individual displays signs of suicidal behaviour. It is recommended that local medical staff, military police, chaplains and SWOs jointly develop these plans and procedures, outlining the duties and responsibilities of personnel from each organization.

Post-intervention

13. Post-intervention consists of measures taken after successful intervention is completed or a suicide has occurred. The purpose of post-intervention strategies is to attempt to reduce the trauma of the member and/or the bereaved, prevent or discourage “copy-cat” behaviour by others, and reconstruct the events that led to the suicide or attempted suicide. Post-intervention is an essential component of the management of suicide, providing comfort and assistance to bereaved family members, friends and co-workers in addition to providing valuable information to be incorporated into prevention and intervention strategies.
14. The following are responsible for the indicated actions in the area of post-intervention:
    1. it is essential for COs to ensure that social support services, including counselling, are offered to bereaved family members, friends and co-workers. COs will also ensure that summary investigations are carried out by an SWO, or, if unavailable, by an officer experienced and mature enough to conduct an investigation with the necessary tact and discretion to deal effectively with the victim’s family, friends and co-workers. If circumstances require the convening of a board of inquiry, an SWO shall be included as a member to ensure family, friends and co-workers are treated in the appropriate manner. COs are also responsible for ensuring that CISDs are provided by a qualified team or individual at the proper time;
    2. the investigating officer will carry out a complete investigation and ensure that all concerned professionals, supervisors, colleagues and friends are interviewed as appropriate. With a view to protecting the individual’s immediate family, when an SWO is not available, family members shall be interviewed only when absolutely necessary and when the required information cannot be obtained from any other source. Guidelines for investigating a suicide are included in Annex A;
    3. base and unit surgeons are responsible for ensuring, in consultation with the investigating officer, that an adequate medical investigation is carried out according to established procedures to help obtain information that could enhance prevention and intervention strategies; and
    4. SWOs are responsible for providing required social support services and for arranging CISDs as requested by the unit CO.

(C) 1605-19-44 (DMS)
Issued 1996-02-16

Index

• Deaths
• Investigations
• Medical
• Physiological / Psychological
• Suicide

Annex A - Guidelines for the Investigation of a Suicide

1. All suicides shall be investigated pursuant to 24-6. A complete investigation should address, but not necessarily be limited to, the areas listed below. In addition, under each area there area number of suggested details that may be significant in certain cases. All interviews shall be conducted with the utmost sensitivity and tact. A complete report may not be possible and investigators should not press individuals for information they are not prepared to divulge.
2. The following are recommendations for the basic areas of inquiry that should be addressed during the investigation of every suicide:
   1. identifying information (from member’s personnel record résumé (PRR)):
      1. name,
      2. service number (SN),
      3. rank,
      4. trade/classification,
      5. sex,
      6. race,
      7. religion,
      8. date of birth,
      9. marital status,
      10. unit,
      11. home address, and
      12. level of education;
   2. details of the incident:
      1. date and time of suicide or attempted suicide,
      2. location,
      3. method,
      4. details of discovery,
      5. communication of suicidal intent (letter, tape, video, etc),
      6. other actions that may have accompanied the suicide, and multiple or pact suicide or attempted suicide;
   3. military work history:
      1. time in service,
      2. time in rank,
      3. time at present posting,
      4. employment history, with particular attention to possible exposure to emotional trauma at work (e.g., through a critical incident, peacekeeping, involvement in a harassment case), and
      5. awards;
   4. work performance:
      1. problems accepting military life,
      2. recent changes in job performance,
      3. problems with being late, missing work,
      4. problems with quality of work,
      5. problems with supervisor, co-workers, and/or subordinates, and
      6. victim’s emotional state as perceived by others at work;
   5. financial status:
      1. describe financial situation including amount of debt,
      2. ability to make debt payments, and
      3. recent business losses, bad investments or failures;
   6. disciplinary history:
      1. criminal record — civilian and military,
      2. time spent in detention (include description of offence),
      3. accusations of sexual misconduct — child abuse, harassment, etc.,
      4. any military or civilian charges pending, and
      5. civil legal difficulties
   7. recent agency contact — prior to committing suicide did the victim contact a professional such as a:
      1. physician,
      2. chaplain,
      3. social worker,
      4. nurse, or
      5. others;
   8. conclusion:
      1. findings:
         1. a statement based on the coroner’s report indicating whether the incident was a suicide,
         2. victim’s state of mind prior to the suicide or attempted suicide,
         3. the most probable reason for victim’s decision to commit suicide, and
         4. a statement as to whether the victim’s supervisor or the medical system had identified a problem before the suicide occurred, and
      2. recommendations — state what actions, if any, could have been taken to lower the risk of suicide in this case.
3. To be complete, the investigation of a suicide should include, in addition to the report of the investigating officer or of a board of inquiry, the following information and reports:
   1. terms of reference for the investigation;
   2. Military Police Report;
   3. Medical Officer’s Report;
   4. Coroner’s Report;
   5. Toxicology Report;
   6. form CF 98;
   7. records of interviews conducted; and
   8. comment on whether CISDs were employed.

Issued 1996-02-16