Today Dr. Jones talks with Rebecca Willis-Nichols, Lexington VAMC Suicide Prevention Coordinator, about suicide prevention in veteran populations. What general understanding should we have about veterans and suicide? What is specific to the veteran population? What help is available?
Rebecca Willis-Nichols, LCSW received her undergraduate degree in Psychology at the University of Kentucky. Following that, she completed her master’s in Social Work. Mrs. Willis-Nichols began working in the Social Work field with children and families; she accepted a position at the Lexington, KY VA Medical Center in 2012 initially working on the residential treatment unit focusing on the treatment of PTSD and/or Substance Use Disorder. In 2015, she began working as the Suicide Prevention Coordinator at the medical center. She has also served as an adjunct professor at the University of Kentucky College of Social Work during the years of 2007-2011 teaching Research in Social Work.
Rebecca Willis-Nichols, LCSW
Suicide Prevention Coordinator/ReachVet Coordinator
TSES/CWT Program Manager
Lexington, KY VAMC
Veterans Crisis Line:
800-273-8255 option 1 (sends you directly to the Veterans Crisis Line)
Transcripts are created using a combination of speech recognition software and human transcription and may contain errors. Please check the full audio podcast in context before quoting in print.
Dr. Jones : [00:00:02] Hello and welcome to the social work Conversations podcast produced by the University of Kentucky College of Social Work. My name is Blake Jones. Here we explore the intersection of social work research practice and education. Our goal is to showcase the amazing people associated with our college and to give our listeners practical tools that they can use to change the world.
Dr. Jones : [00:00:25] I’m joined today by Rebecca Willis-Nichols from the Lexington V.A. Rebecca is the suicide prevention coordinator. Welcome to the podcast.
Rebecca: [00:00:36] Thank you for having me. I’m excited.
Dr. Jones : [00:00:37] It’s good to see you. And I’ve gotten to know you a little bit through our work group that we’re that we’re working on our suicide prevention work group. We’ll talk a little bit about that in a moment but I kind of wante to start and find out what your story is about what drew you to social work and what kind of social work have you done?
Rebecca: [00:01:00] Well growing up I always knew I wanted to be a social worker. I’ve always had a helper soul. That’s what makes me happy. You know it’s not work for everybody. You have to also be able to tolerate it and carry it. And it’s something that I’ve been able to do. So that really drove me to want to be a part of the social work community I’ve always been a giver. And what drew me to the V.A. My husband’s a veteran. And so initially I worked with children and families and that was that was really hard work and I had kind of hit my limit with that and I felt like it was time to move on and my husband and I had just met and I started to feel a real passion for supporting the military supporting the veterans. I had become a part of his role in the guard in his life with his friends and his family and I had a few other family members that were in the military. So it was just kind of a piece of me that I thought you know I’ve never really had any expertise in this area or real experience in this area. But I think it’s something I’m interested in and I think it’s something that I could learn to love it something that’s an honorable mission. But I feel good about going to work each day. It’s meaningful work. So that’s really what brought me there.
Dr. Jones : [00:02:09] Yeah. So what other kind of social work have you done in your career.
Rebecca: [00:02:14] So I worked in home with children and families doing a lot of child based psychotherapy play therapy initially and then doing a lot of couples counseling and the parent child interaction therapy initially. And then when I’ve moved to the VA worked for a while on the residential unit treating PTSD and treating substance use. And then I moved into the role of suicide prevention coordinator about three years ago. Actually I get the opportunity to wear a couple of different hats at the Lexington V.A. I get the opportunity to work in suicide prevention but I also work in that PTSD clinic and also work in the CWT program and that program specifically it’s jobs for veterans that are struggling with disability.
Dr. Jones : [00:02:58] CWT What does that stand for?
Rebecca: [00:03:01] CWT stands for compensated work therapy. So it’s giving our veterans an opportunity to come back home have you know whatever civilian struggles they’ve had whether it’s legal involvement or substance use or mental health issues whatever that looks like for them at any age range frankly when they first get back or when they’re older adults and it looks that it didn’t find any kind of employment barriers for them. And then figuring out how to find a place of employment that can support that that we can job carve that will have accommodations for them. So I kind of have the balance I have the suicide prevention work which can be really sad and really heavy and then I’ve got the compensated work therapy work which can be really hopeful and really exciting.
Dr. Jones : [00:03:46] We’ve done a couple of other podcasts on veterans and this is something that I’m really interested in because it seems we have so many were involved in a couple of wars still and it seems like we have so many veterans returning home young veterans that are disabled in some way or have PTSD or just have a lot of challenges. And I wonder if you could talk about what what are the special challenges of returning specifically a young veteran that’s coming home that may be you know 21, 22 years old.
Rebecca: [00:04:24] Absolutely.
Dr. Jones : [00:04:25] Talk about that a little bit.
Rebecca: [00:04:26] So one thing to keep in mind is is you’re right. We’ve got several ongoing wars and we have several maybe not necessarily wars but conflict areas that we have continued to populate for decades and decades and probably will from here on out. And we are also bringing home our veterans at a higher rate now that we than we used to. So in wars past our battlefield medical interventions were not as advanced as they are now. So we bring home veterans now that come home with amputations they come home with traumatic brain injuries. They come home with really severe PTSD or depression and they’ve been deployed numerous times. So the multiple deployments the length of our deployments are now longer with the current wars that we have. And so that’s going to increase someone’s rate of experiencing PTSD you know potentially increase the number of traumas they’ve experienced. They also are coming home to a civilian world who I think supports them on the one hand and wanting them to keep conflict off of our shores but not really knowing how to embrace them and support them when they get back home. These skills that they’ve learned in the military are invaluable. But think about trying to write a resume if you’ve been a tanker driver right now or you’ve been in the infantry – you know those skills don’t translate real well over to the civilian world so a veteran comes home. They’ve had multiple exposures. They’re young they’re very young when they go over they may have multiple medical conditions when they return. They’ve had multiple exposures potentially to chemicals so they’ve got medical conditions that you can see in some that you can’t see. They come home to their family who doesn’t necessarily have the knowledge or the skill set to support them. They love them but they may not know what to do with them. They are coming home to – just this civilian role that’s not quite ready to have them yet. I think that’s the biggest thing that we see at the VA we’ve got a lot of programs that are in place to help transition our veterans. We’ve got transition care management and we’ve got early enrollment of veterans and myself as the suicide prevention coordinators all the other coordinators across the nation we all have relationships at the DOD because they have mirror roles to us. There’s a suicide prevention coordinator in the DOD as well. And so we’ll get information about veterans as they’re transitioning out to help prepare them. We can give them information about the V.A. But you know it’s just a real it’s a real change.
Dr. Jones : [00:06:55] Yeah I want to kind of move – You mentioned suicide prevention which is really what I want to talk with you about on this podcast and this is kind of the initial way that you and I got linked together. You asked me to serve on this committee and I wonder if you could talk a little bit about suicide among veterans. Give us some numbers of how bad it is. Do we see any hope in preventing some of those. Talk with us a little bit about that.
Rebecca: [00:07:27] So the veterans suicide rate in Kentucky is higher than the national average and that’s across all of our age groups. So that’s something to be mindful of and it’s actually high in our southern region of this nation as well. Many of our veterans are primarily dying by firearms. And then the number of veterans that are dying a day right now that statistic has come down from 22 down to 20 which is great progress. But 14 of those veterans a day die by suicide don’t come to the V.A. for health care. So we as providers don’t get the opportunity to meet with them to provide any interventions to them. Any special education or specialized support that we can provide our veterans because they’re not coming to see us. And of those six that are dying today by suicide. Only about half of them are seen in mental health. And so you know even our mental health providers were only able to get a small sliver of the veterans dying a day to really have any impact on. So last year Secretary Shulkin who was the V.A. secretary initiated these Eliminating Suicide initiatives across the nation. Each V.A. was asked to develop know initiative for their site what would work for them. So within our region which is Kentucky and Tennessee we decided to develop the Eliminating Suicide work groups. These work groups are really unique to what we’ve been doing – the VA Medical Center does a really good job in-house of having policies and procedures in place in screenings in place and asking the right questions and making sure all the staff know what to do if they get it an answer that a veteran’s at risk in making sure there’s lots of research being produced out by all of our you know big research facilities for the VA. But the piece that we’ve really missed is going out in the community VA have been behind big brick walls for a long time now and we’ve not been available to our communities and really the mission is to “care for him who borne the battle and his widow and his child.” So really our responsibility is to the veterans but also to the family.
Rebecca: [00:09:28] These families and friends loved ones really serve as their primary support for our veterans. And if we’re missing that piece we’re missing a huge piece the huge link to saving some of their lives and most of the veterans that are dying they’re not calling they’re not calling to talk to me. They’re not calling to talk to their individual therapists or their primary care doctor. The last conversations that these veterans are having are with their their wives their spouses their best friends their their girlfriends their brothers mothers fathers with their loved ones as of the last conversations and those people they don’t necessarily know what to do with that information. They don’t know who to tell or who to call or how to help. And that’s a real focus for the Lexington V.A. We want to make sure that we’re getting the word out and getting some training to those informal nonprofessionals that our veterans are interacting with. We’ve got so many veterans in Kentucky. They’re everywhere.
Dr. Jones : [00:10:22] Yeah. I went to one of the trainings the other night in my hometown and it was very interesting. It was it was well done and I thought it was general enough you know to kind of really apply to anyone who was listening. I wonder if you could talk a little bit about what if someone is listening to this podcast a family member or or or therapist or anyone. What are the things that they should really be aware of in terms of suicidal behaviors thinking in a veteran what should what are the red flags?
Rebecca: [00:11:03] Well I think some the red flag is first to recognize that anyone and everyone can be at risk. So don’t fall into the category of my veteran or frankly my loved one has never said anything to me about thinking about suicide. They still might still be thinking about it. So anyone’s at risk. So be mindful of that. I think some of the things to look for is if you’ve got a veteran that is withdrawing if you’ve got a veteran who’s isolating themselves if you’ve got a veteran who is increasing their substance use they started drinking a whole lot more. They’ve advanced to an illicit says substance that’s harder or more if they are no longer attending to their daily activities so they’re no longer going to work they’re no longer going to school there are no longer showing up to family functions. They’re no longer caring for their hygiene or running errands. If you notice that your veteran is struggling with with sleep or struggling with social interactions he knows that they’re isolating. I think those are all some of the real early warning signs to be on the lookout for. I also think that it’s wise it’s a very very wise to secure the firearms that are in your home regardless of whether you believe everybody should have rights to firearms or anything like that. That’s not the point. The point is is that the majority of veterans in Kentucky are dying with the use of a firearm and the majority of them have weapons. I think I heard that the majority of veterans have an average of six weapons in their possession. And so when you’re looking at helping your loved ones secure their environment sure there’s a gold standard. No weapons in the home. They’re completely sober they’re attending treatment. Yeah that’s the gold standard. But it’s really about aligning with your vendor and letting them know that they’re not alone that they have the support in you that you are going to be able to hear them if they say yes this is what I’m struggling with. Oftentimes our veterans don’t want to share with their loved ones because it’s a pretty heavy statement to tell someone. I’m thinking about killing myself or I don’t want to live anymore. That’s really heavy that’s hard to hear. It’s hard to say. And our veterans don’t necessarily want to burden their loved ones with that. So just thinking in advance of how you can make the environment safe I think those are a couple of things.
Dr. Jones : [00:13:25] Yeah I think some people you know part of the training the other night was talking about myths of suicide and you know we talked a little bit about the the myth that you know people that say they’re going to kill themselves sometimes are just being manipulative and you should ignore that. And I wonder if you could talk a little bit about those kinds of myths.
Rebecca: [00:13:48] I think there’s a lot of myths. I think that you know the myth who you mentioned there of you know if somebody says they’re going to kill them so they’re just wanting attention or are they’re not really going to do it. Well you know somebody’s coping has decompensated to the point that the way that they feel like they’re going to get their needs met is to say I want to kill myself that’s really profound. That’s that’s different than somebody who is successfully coping with what’s going on around them. And so I think that those statements are still really really important to take seriously. If they’re looking for attention they’re looking for an unmet need that’s a valuable piece of information and that’s something that we need to intervene on. I think there’s been a lot of myths over the years that we’ve had the opportunity to debunk the myth of if you’ve got clinical depression then you’re suicidal or no one’s ever suicidal unless they’re clinically depressed. Yes. Those two things are are heavily related but they’re not necessary. Someone can feel suicidal and not also have depression or vice versa. And I think that some of the other myths for example is if somebody is going to kill themselves they’re not going to tell anybody that’s not true at all. There’s lots and lots of research that tells us that the majority of people will actually show risk factors or say things to their loved ones and those last few days prior to having a suicide attempt of these people. They want to live. It’s against our natural instinct to die by suicide. We have a very strong self-preservation and and so it’s really against our grain to want to die by suicide and the majority of people are looking for help. You know the other thing the other myth that I hear commonly is “Well so-and-so has kids” or “they have this new job coming out” there’s some kind of future planning in the works and so there’s future planning then they’re not they wouldn’t kill themselves. Well that’s a great barrier and that’s a great you know thing to capitalize on in terms of treatment. But there’s a lot of ambiguity that comes with wanting to die by suicide and it will come and go waxes between: “Yes I want to die by suicide. Yes I want to live.” But really in reality especially for veterans what we have found it’s not that they want to die they just don’t want to live the way they are.
Music: [00:16:24] .
Rebecca: [00:16:24] They don’t want to live feeling different than everyone around them. They don’t want to live with the memories of the things that they had to do or that they saw or were a part of. They don’t want to live with the physical or emotional pain of things they don’t want to live with maybe feeling like a failure or feeling disconnected or feeling as though you missed and are feelings of grief or moral injury they just don’t want to live like that. And so if you can offer an alternative or an out to that something different than living how how they are then generally people are going to capitalize on that and are going to take that olive branch they’re going to take you up on that. And that’s part of what the training focuses on is is identifying some of the statistics that’s always important. Kind of get a framework for what we’re looking at but then it also identifies some of the myths that you and I spoke about it does identify some of the risk factors and warning signs that we’ve talked about and then it talks about what resources are out there. And really you know it’s never one single action or one person that prevents or causes suicides certainly but we can all play a role in referring our veterans to where they can get the help that they need.
Dr. Jones : [00:17:35] I really liked the practical aspect of the training that I went to the other night. You know we had the PowerPoint point in the discussion of course but you also are the trainers also brought gun locks and I don’t even own guns but I got a couple of gun locks to take for some of my clients I work with lots of police officers and some veterans as well. And I think just that very practical step of giving somebody a gun lock. Well I think what you’re talking about is the fluidity of suicidal ideation, right? Absolutely. Can be really strong and it kind of waxes and wanes and if if we can prevent someone from just going and grabbing a gun or at least having to go find the lock the key to the lock to unlock the gun. That simple act alone could save their lives.
Rebecca: [00:18:29] And that’s a huge piece of safety planning. So we’re looking at interventions for someone that show was suicidality that means restriction keeping the environment safe is the one that’s got the most research behind it and really it’s it’s the recognition that your commitment to die by suicide will wax and wane. You know oftentimes our veterans are intoxicated when they make these decisions and so they’re not in their right mind or they have woken up from a nightmare or they’re in the midst of a flashback and are going to what they know which is their firearm which was their safety when they were in country. And so just securing it for those times I think is super important and also you know a lot of our veterans don’t want want to necessarily secure their firearms. But if he can get as many steps between the vertern/the person’s thought their commitment to die by suicide and obtaining a lethal means – that’s a win. So maybe they won’t use a gun lock today but maybe they’ll separate the ammo. Maybe they’ll secure one of their firearms maybe they’ll give a couple of firearms to a family member. The VA has a very large gun lock campaign on our side alone. I can request up to a thousand gun locks as many times year as I want. I usually get about a thousand gun locks about every four months. Now we give those out all over our half of the state that we’re responsible for. And we’re happy to give them to civilians alike frankly with no questions asked.
Dr. Jones : [00:19:58] That’s great. I love that just that simple thing is so powerful I think. Rebecca I want to welcome you kind of back home here to the University of Kentucky College of Social Work. Tell us a little bit about your education.
Rebecca: [00:20:10] I went to UK as an undergrad I got my undergraduate degree in psychology and then I came over to the College of Social Work for my master’s degree and then I worked for a few years even on my Ph.D.
Dr. Jones : [00:20:22] So you’ve been around here a lot.
Rebecca: [00:20:24] It feels like home coming back to me with you. Yes I have lots of fond memories.
Dr. Jones : [00:20:29] Well Welcome back.
Rebecca: [00:20:30] Thank you.
Dr. Jones : [00:20:31] I wonder if you could tell us a little bit about social work’s unique role in the prevention of suicide.
Rebecca: [00:20:38] Social work and suicide prevention I think honestly are made for each other. It is such a macro level of practice at least in my role. So my team at the at the VA is fantastic and they are the ones that primarily deal with the veterans so my role is pretty heavy on policy on writing procedure on building community relationships and coordinating trainings kind of the big macro level scope of things. But I think that part of what suicide prevention is is that looking at all the different facets of somebody’s life so it’s real heavy on that psychosocial component and recognizing that suicide prevention is you know essentially everyone’s business and that it requires harmony in amongst all the areas of someone’s life. So harmony at work harmony with their sense of self able to get their needs met. Whether that’s a food bank referral or job or retirement plan whatever that is for that. And so it’s real heavy with case management and it’s really heavy with having a giving heart and being a helper.
Dr. Jones : [00:21:47] Yeah – and you see I think the interconnectedness of the challenges facing returning veterans.
Rebecca: [00:21:55] Um-hum.
Dr. Jones : [00:21:56] Right. It’s not just about their mental health or their or what are their physical health or whatever or their family. This is all very connected. And so your approach has to be connected.
Rebecca: [00:22:06] And I think that that’s one of the skill sets that social workers have. Maybe some of the other disciplines have some expertise in other areas which are just as valuable. But for social workers we are so heavily trained and interested in looking at the interconnectedness of all of those things to someone’s life recognizing that all of it plays a really important role. We can’t advance to you know treating depression for example or PTSD or even suicidality for that matter. If if their basic needs are met if their families are provided or if they can’t feed their kids if they don’t have enough of an income if their medical needs are not met you know it’s all it’s on a hierarchy and I think that’s a real strength for the social workers.
Dr. Jones : [00:22:47] Yeah well I want to kind of finish up by asking you the self-care question which often do on this podcast. You are a mother of young kids a couple of boys that are pretty young and your husband is a veteran. Right. And you have this really responsible job I came over and saw you the other day the V.A. and I saw just kind of the stress in your job. So I wonder how you maintain balance in your life because I think especially in our work that’s so important that we that we do that. How do you do that for yourself.
Rebecca: [00:23:31] I think for me it is play. I was thinking about you know what I would want to share about this question and how I really practice self care in my life because it’s something you have to be real meaningful and intentional about or it will get away from here. So I was thinking how did I spend my time this weekend and it was worth playing – my boys are six and three and that opportunity to sit with them on the floor and their pure innocence and joy and their knowing nothing of the darkness of this world some something that I can get lost in and that is refreshing for me and that’s absolutely what is nurturing for me.
Dr. Jones : [00:24:10] Yeah, That’s good. Well I really appreciate you coming on Rebecca. And if somebody wanted to reach out and get you know get one of these trainings out of their church or library or get some help. Let’s give some resources for people so how would they do that.
Rebecca: [00:24:30] Okay – So you can call me and my numbers 8 5 9 2 3 3 4 5 1 1 and my extension is 3 2 2 3 and either I’ll answer the phone or one of my teammates will answer the phone. It’s a general voicemail line. So the other thing that is I would encourage everybody to share far and wide the Veterans Crisis Line which is 1 800 273 8255 and have our Veterans Press 1 to the Veterans Crisis Line. It’s a general crisis intervention line for the U.S. And so anyone can call this number. And when you call this number at the onset you get some options press 1 sends you directly to the Veterans Crisis Line. You could press another number and it would send you the homeless support line for example. But the Veterans Crisis Line is actually staffed by VA employees the majority of them are veterans and so our veterans and our loved ones have access to this line 24 hours a day they can call in and talk with a veteran talk with a trained crisis responder who can help them in that moment and really in terms of the crisis front – It’s really ideal that they call the Veterans Crisis Line rather than their local VAs even if it is during business hours so the Veterans crisis line has the unique opportunity to be staffed by a phone with multiple responders around the clock. But they also are able to ping cell phones and find veterans locations. So for example if somebody calls me at the likes VA and if they won’t to tell me where they are there’s nothing I can do is sit with them and be on the phone. So really ideally getting this Veterans Crisis Line number out as far as wide is going to be the best.
Dr. Jones : [00:26:06] That’s good. Well I want to thank you for spending some time with me this has been so helpful for me as part of this work group to really understand more about your work and kind of where we’re going as as as a work group. I just want to thank you for giving your professional life to such an important subject I can’t think of really anything more important than helping to save somebody’s life. And I know that you’re part of a team that does that but I just want to thank you for that and really appreciate your work and good luck.
Rebecca: [00:26:41] Thank you for having me on. I really appreciate it.
Dr. Jones : [00:26:45] You’ve been listening to the social work conversations podcast. Thanks for joining us. And now let’s move this conversation into action.
Announcer: [00:26:56] This production is made possible by the support of the University of Kentucky College of Social Work. Interim Dean and Vale and all the faculty and staff who support researching contemporary social problems and prepare students for the social work profession hosted by Dr. Blake Jones produced by Jason Johnston with thanks to our webmaster Jonathan Hagee. Music by Billy McLaughlin. To find out more about the U.K. College of Social Work and this podcast visit socialwork.uky.edu/podcast