Annex H: Suicide Awareness and Intervention Education in the CF

The Canadian Forces health promotion program is Strengthening the Forces (StF), and resides within the CF Health Services Directorate Force Health Protection. The StF Subject Matter Experts (SMEs) are responsible for policy and program development, program implementation and evaluation. StF programs address primary prevention by adopting a population health approach, by pursuing programming with demonstrated efficacy and are not positioned to address diagnosed clinical health requirements. StF activities work towards the establishment of healthy work environments and in the development of skills to enable CF personnel and their families to maintain and improve their health.

The StF health promotion programs are delivered across the Bases and Wings via Health Promotion personnel. The four core programs are: Nutrition, Injury Prevention, Addiction Awareness and Prevention, and Social Wellness. Suicide awareness and intervention is part of the Social Wellness health promotion programming.

Strengthening the Forces (StF) has provided suicide awareness training since 2005 using the proprietary ASIST materials purchased from, and owned by, Livingworks. From 2005 to 2008, 288 two-day ASIST workshops have been delivered to 2,869 Regular Forces, 494 Reserve Forces, 1,065 Civilians, and 55 Family Members. In 2009, an evaluation of the two-day ASIST workshop was released.¹ Pre and post self-reported evaluations of ASIST courses given within the U.S. Army stated that 90% of the participants reported more than average confidence to help a person at risk for suicide after taking ASIST. The evaluation recommended that personnel who interact regularly with soldiers should take ASIST. The post-course and utilization rates are unknown.

Given the cost/benefit of in-house CF-specific programming, in the summer of 2009, a 3 hour suicide awareness workshop was developed by StF for a CF audience. The StF Suicide Awareness Workshop provides information and a process of intervening if and when necessary, explores myths and facts about suicide, explains the suicidal process, outlines resources in the CF and introduces the “ACE intervention process" (used with permission from the U.S. Army). ACE stands for: Ask: ask about suicidal thoughts; Care: Understand that person may be in pain; and Escort: Take person to someone who can help.

In addition to the suicide awareness and intervention programs, StF offers Social Wellness health promotion programs that correspond to risk factors implicated in suicide.^{2, 3} Stress: Take Charge: is a stress management workshop with components on stress and military life; creating social networks and building personal resilience. Managing Angry Moments is an anger management workshop for CF personnel who would like to improve how they respond in difficult situations. Basic Relationship Training is an effective communications workshop for couples. In addition, within the Alcohol, Other Drugs and Gambling Awareness area of health promotion, there is a CF Drug Control Program which is mandatory supervisor training for all CF members in leadership positions (DAOD 5019-3). The training consists of two parts: Recognizing and Responding to Early Warning Signs and Developing Effective Interview Skills.

1 ASIST Evaluation HQDA Tasker No. 09013001, April 2009

2 James LC, Kowalski TJ. Suicide prevention in an army infantry division: a multi-disciplinary program. Mil Med 1996; 161:97-101.

3 McDaniel WW, Rock M, Grigg JR. Suicide prevention at a United States Navy training command. Mil Med 1990; 155:173-5.