Case Study 5
Instructions: Spend 5-10 minutes reviewing the case below and considering the questions that follow. (Rationale and discussion is displayed at the bottom of this exercise)
Jack is a 65-year-old retired Lieutenant Colonel in the Army. He was on active duty flying helicopters during the Vietnam War, airlifting casualties to medical centers. He enjoyed a 45-year marriage to his high school sweetheart. They have three grown children with a dozen grandchildren. Jack has enjoyed a post-military career as a consultant to the Department of Defense at the Fort Lewis military base in Tacoma, Washington. He retired 2 years ago so that he and his wife could enjoy traveling and visiting the children and grandchildren. Jack’s wife became ill last year and struggled with ovarian cancer that she succumbed to after a 6-month battle while undergoing chemotherapy. Jack’s connectedness to social events was primarily through his wife. She was actively engaged in her church. When Jack’s wife died, he withdrew and lost much of that connectedness. His daughters and friends attempted to get him into grief counseling or to attend a bereavement group with the Hospice who took care of her. He had participated in group meetings a couple of times and then brushed off any further contact. He had a couple of months where he seemed to “bounce back;” however, he has begun to struggle with nightmares and flashbacks since her death. He is barely sleeping. He has attempted to connect with his war buddies; however, that has stirred many memories from the long-ago war. In addition to his wife’s death, many of the repressed feelings from the war have begun to plague Jack, and he has become more despondent, reclusive, and depressed. His children live hundreds of miles away and do not realize the changes in their Dad. Based on their contact, they believe that he is still attending the bereavement group. His daughters call once a week. At the time of her weekly phone call, his oldest daughter could not get a hold of him…. She persists without an answer and calls the neighbor, who admits not having seen Jack for a few days. The police perform a welfare check and find Jack lying on the floor of his house with an apparent self-inflicted gunshot wound and a suicide note.
1. Based upon the information provided, which of the following strategies would be least effective in Jack’s scenario? A. Refer Jack to a behavioral health provider. B. Direct Jack to the Veterans Crisis Hotline. C. Connect Jack with a support group for veterans struggling with grief. D. Report the situation to the local parish.
2. Veterans with a _________________are at a greater risk of suicide. A. Traumatic brain injury.
B. Poor diet. C. Back pain. D. Migraine disorder.
3. In Jack’s case, considering the discussion regarding reducing access to lethal means, which action by family or friends may have been taken? A. Educating Jack regarding what to do when he has suicidal thoughts. B. Call the police and have them do a welfare check.
C. Remove any firearms from the house. D. Call the local parish for assistance.
Rationale for Question 1: The best option is D. The Veterans Crisis Hotline is available 24/7 for veterans who are in a crisis or struggling with depression, despondency, or feelings of suicide. Grief counseling and support groups both for veterans and in this case, Jack’s loss of his wife is a critical intervention through a crisis moment. Grief counseling and support groups and the Veteran’s Crisis Hotline can provide crisis intervention and mental healthcare support. Rationale for Question 2: The best option is A. Studies support that traumatic brain injury coupled with other risk factors found in the general population (substance abuse, depression, etc.) can increase the veteran’s risk of death by suicide. Rationale for Question 3: The best option is C. Family members concerned with a veteran’s safety can request a gunlock from their local VA suicide prevention coordinator. In addition, at minimum the weapon should be locked and unloaded and, if necessary, a temporary off-site storage may be advisable. Discussion : While Jack’s family may not have been fully aware of his severe depression, Jack had many risk factors for suicide. These included: his age (the elderly are at higher risk for suicide); the recent death of his wife and subsequent loneliness; social isolation; a history of trauma during his military career, and current symptoms of PTSD (nightmares, flashbacks); sleep disturbances; and untreated depression. All of these risk factors place Jack at a higher risk for suicide. In the aftermath of Jack’s death by suicide, his friends and family members should receive grief to help them cope with the loss of their daughter.
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