STMSS01 - Dr. Barbara Van Dahlen - PREVENTS Task Force

Dr. Barbara Van Dahlen, Executive Director of the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) Task Force, joins the show to talk about how the Task Force is developing an action plan to impact suicide in the military population

About Today’s Guest:

Barbara Van Dahlen, Ph.D., named to TIME magazine’s 2012 list of the 100 most influential people in the world, is the president of Give an Hour. A licensed clinical psychologist who has been practicing in the Washington, D.C., area for over 20 years, she received her Ph.D. in clinical psychology from the University of Maryland in 1991. Concerned about the mental health implications of the wars in Iraq and Afghanistan, Dr. Van Dahlen founded Give an Hour in 2005 to enlist mental health professionals to provide free services to U.S. troops, veterans, their loved ones, and their communities.

Working with other nonprofit leaders, Dr. Van Dahlen developed the Community Blueprint, a national initiative and online tool to assist communities in more effectively and strategically supporting veterans and military families. Give an Hour has implemented the Blueprint approach in two demonstration sites and continues to lead community collaboration projects.

In June of 2019, she was named the Executive Director of the Task Force to create the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS).

Episode Transcript:
Duane France:  (00:00) Welcome to episode one of the seeking the military suicide solution podcast brought to you by the military times. I'm Duane France

Shauna Springer: (00:07) And I'm Doc Shauna Springer

Duane France:  (00:08) And we'd like to thank you for taking the time to learn more about suicide in the military affiliated population.

Duane France:  (00:22) Thanks again to everybody for joining us to listen to an honest conversation about service member veteran and military family suicide. Our guest today is Barbara Van Dahlen. Shauna, how about you tell us about the guest.

Shauna Springer: (00:34) Sure. Dr. Barbara Van Dahlen is a clinical psychologist who serves as the executive director of the task force to create the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide. What's called PREVENTS. Prior to spearheading the efforts of PREVENTS, Dr. Van Dahlen and founded Give An Hour in 2005 based on her concern that as a nation, we would not be ready to respond to the needs of those who have deployed to the Wars in Iraq and Afghanistan. As president of Give An Hour, Barbara led efforts to create a national network of mental health professionals who provide free services to us troops, veterans, their loved ones and their communities. Like many people who become leaders in the field, Barbara's work is not just a job. It's personal. After serving in the Pacific during world war II, her father came home with post traumatic stress. At the time, there was no concept of what PTSD is and how it can be treated like there is today. Barbara and her father were very close and she admired him for his strength, especially as he stepped into the role of being a single father for much of her childhood. So Give An Hour was established in large part because of Barbara's lived experience and the resultant clarity in her perception that we need to do a better job at supporting those who serve in our military. In today's episode, she and Duane discuss the concrete aims of the task force and her philosophical approach to the work of suicide prevention.

Duane France: (02:01) That's great. I really appreciate that. Whenever we were thinking about who the first guest should be, or lining up the guests, obviously the prevents task force where it is right now and where it's going to be going, she was definitely one of the first ones that I thought of, and that you agreed, would really be important to come on the show. So let's get into the conversation then. You and I will come back afterwards to pull out some of the key points.

Duane France: (02:33) So the PREVENTS Task Force, I've been hearing about it for a couple of years, obviously it's been in the works. President Trump signed the executive order back in March and now it's a thing. So if you can give us maybe a little bit of an overview of what the PREVENTS Task Force is.

Dr. Van Dahlen: (02:50) Sure. So maybe this will help frame why this is such an extraordinary issue, at least from my perspective and why I was so honored to take the position. So I was aware as many people in our community, those of us who are working to support military veterans, you know, related to this work, suicide prevention, mental health in general. I read the, the executive order in March when it was signed. I was actually then at that point the president of Give an Hour, the organization I ran for 15 years that I founded, I was asked to read it by a news outlet that wanted me to comment on it. And so I read it and I thought, this is extraordinary. We have never seen an effort from the federal government focused on addressing a challenge, a societal challenge like suicide. So that was my reaction.

Dr. Van Dahlen: (03:48) I was like, Oh my gosh. And the opportunity to pull together across agencies was just as I said, extraordinary. And so little did I know a couple months later I was called and asked whether I would consider running the task force becoming the executive director. And I was, you know, I said I was honored. And so, so began my journey with this work. The executive order, PREVENTS is the acronym, stands for the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide. And both of those pieces doing are really important. Why? Because people who are empowered, people who feel like they have purpose, they have mission, people like that are much less likely to die by suicide. And we can talk more about that. The other half of that acronym, end a national tragedy of suicide, suicide is not just a concern in our military and veteran community.

Dr. Van Dahlen: (04:48) Suicide is on the rise in our nation. And in fact, suicide is now the second leading cause of death for people aged 10 to 35. 10.  10 year olds. And so this is an opportunity. Yes, our goal with some of the parts in particular, some of the funding that will eventually flow, so the research is very, very focused on veterans, but that's not all we're focusing on. This is an opportunity actually for our veterans and our military community to lead the way as we tackle suicide broadly. So this effort is an all hands on deck. It is about interagency coordination, collaboration. It's about working with our community partners, diving deep into our communities to ensure that we knit together efforts that are currently there. The last thing I'll say is that a piece of this work, and for me, perhaps the biggest piece, this is a public health approach. We've never done this before. We have never tried to address suicide on this massive scale from a public health approach.

Duane France:  (05:57) Right. And, and that's what I find interesting about this. It's all out there. All the resources are out there, but it's more of a facilitation role rather than, you know, somebody taking the lead. You know, we're all digging holes, but nobody's telling us where to dig the holes or how effectively to dig them together.

Dr. Van Dahlen: (06:18) Yes. Well, and I think to your point, the public health approach, you know, people use that phrase, but not everyone knows what it means. And really, the focus of public health, we've seen it, you know, over decades that when we take on a challenge and issue and we applied this notion of it's public health issue as opposed to only trying to find those people who are at high risk, that's a part of this. But for too long we have tried to find the needles in the haystack, those veterans those service members in this case, in this community who are struggling, who are hurting, who were suicidal. If we could have done that, we'd be done. We'd all, we'd be going, okay, anybody who's got, you know, suicidal ideation, come on in. It doesn't work that way.

Dr. Van Dahlen: (07:12) So rather than continuing to look for the needles, we're not focusing on the haystacks. That doesn't mean we aren't still looking for [people at risk]. And that's a part of this, of a public health approach. You start with a sort of an inverted triangle, you know, that's the way I visualize it. At the top, you have the widest part of the triangle and the messaging and the efforts and the awareness and the education, and the call to action. That's for everyone. Meaning everyone in our country. Veterans, non-veterans, active duty. That's why we're working with DOD and, and all of the agencies. It's inter-agency. So we start with that broad population. We've got to tackle suicide broadly. Then in the middle of the triangle you have people who are at greater risk, those who have, and we know what those risk factors are. We know that there are a number of risk factors that are not all mental health related, some have to do with financial stress and collapse.

Dr. Van Dahlen: (08:06) Others have to do with chronic pain or substance use and  addiction. And there, there are obviously as well mental health risk factors, you know, if depression runs in someone's family or if they've experienced trauma, repeated trauma or if they are dealing with post traumatic stress. So that that's that middle band and we definitely are targeting and want to both understand how to reach people, how to help them, how to bring hope back into their lives so that they do not fall into the tip of that triangle. Those are the people who are at very high risk. People who have attempted before, perhaps multiple times. People who are chronically struggling with severe depression, who have chronic substance use, serious illness. We have that tip. So public health approach is really going after in this case, preventing suicide by doing all these things.

Dr. Van Dahlen: (09:05) Research is a huge part of this, but it's not research for research sake. This is not about creating more studies that will just become, you know, thick reports that sit on someone's shelf. This is on creating what we're calling a research ecosystem. How do we gather research that is out there in disparate places? How do we integrate data? How do we share data? And again, I'm talking now not only within the government but also in the private sector. Looking at health insurers, as they're part of this conversation. Looking at big technology companies. Most importantly, how do we take all this data, crunch it, and then translate it into knowledge that can be applied at the community level? Because that's where we want to be at the community level, ensuring that community efforts, organizations have the tools, the knowledge, and then we're going to track it all to make sure that we can demonstrate what's working and we can then adjust if we find something that isn't working,

Duane France: (10:11) That's great. It's something as you said, we've, we've needed for a very long time and it's been a big gap. I love a theory as much as the next clinician but I'm more interested in the practical application of that theory. I really liked that visualization of the, the upside down triangle and that needle in the haystack is in that, that, that bottom point, going back to what you had said about empowerment it's interesting because it comes to my mind that suicide prevention is something that is done to someone, not by someone that we try to prevent suicide to those people in the point rather than try to get everybody to do it.

Dr. Van Dahlen: (10:51) Yes. And try to lift people up so they never get there. So as a child psychologist, I'm always thinking about development prevention, early intervention because we don't want people to be at that hopeless dark place where it's much harder, much harder for them to recover from that place. If we reach them earlier with basic knowledge and information that helps them understand what they are experiencing and that it means something and it is not something to feel ashamed of or guilty about or that they need to hide from others. One of the messages that you are going to be hearing a lot coming out of PREVENTS is that we all have risk factors. Every single one of us, we have risk factors for a number of conditions. It's part of being human. We all have risk factors for suicide. Some of us have more, some of us have many.

Dr. Van Dahlen: (11:43) That doesn't mean we're suicidal at any given point in time, but if we know our risk factors, then we're much better able to, to reach out, to engage in protective activities ensuring that we're connected to people, ensuring that we are taking good care of our emotional health and wellbeing. So there's going to be a lot of messaging coming out. Last thing I want to say about that is, I hope this sort of resonates with people, everyone who dies by suicide, at some point in that person's life, they were not suicidal. And our job is to make sure that we get the right information and tools into the hands of people at that point because waiting until they're at the, you know, crisis point, for many people it's, it's too late and we may not be able to pull them back. That's why the preventive acronym is so, so powerful, so accurate.

Everyone who dies by suicide, at some point in that person's life, they were not suicidal. And our job is to make sure that we get the right information and tools into the hands of people at that point

Duane France:  (12:59) You know, something I often tell my clients is, we don't prepare for the storm when the storm is imminent, we prepare for things. People in Miami prepare for hurricanes, hopefully decades in advance. And so, you know, the idea of let's stop it before it starts. The best way to stop smoking is to never start smoking. Looking at another, you know, public health issue. And also knowing that if I have risk factors for cancer, if I do start smoking, that's going to increase those chances.

Dr. Van Dahlen: (13:31) Yes, absolutely. And so, you know, there's a lot of these pieces of this conversation that are, “yes, you know, wow, this is so complex.” Indeed it is. But there are also a lot of things that are very simple, in a way, that everyone can do. Everyone can work on talking more openly about the challenges that we all face. Everyone can work on reaching out to somebody who they know is struggling and you don't have to have the answers. You don't have to be a mental health professional. You can be there for someone else. You can say, I see that you're hurting, I see that you're struggling. I want to be part of this solution. I want to help. You know, this is something I'll also, that we talk about a lot on my team as we're building this massive effort.

Dr. Van Dahlen: (14:21) And there are over a hundred people who've been working on the PREVENTS building this roadmap. And we often talk about if I developed cancer, if I got a diagnosis of cancer, my husband would be at my side every step of the way at doctor's appointments, figuring out treatment options, figuring out things to do to ensure, you know, that I was keeping my spirits up as we were searching for a cure, as I was going through whatever treatments. People would be bringing casseroles to the house they'd be taking care of my kids. We don't do that around mental health challenges and, and there's really no good reason why. The shame and the guilt that has as you know, developed, and, and it's not to blame our society because this is, this is a global phenomenon. We don't like to feel vulnerable and, and we can't see this kind of illness or this kind of injury the way we can see or look on a scan and see cancer, but we have to change that. And that's where everyone can play a role in preventing suicide.

Duane France:  (15:24) Yes, I've seen the same thing. This is something I think NAMI has really said this isn't a casserole. And kind of situation. But you're talking about the roadmap. And so I'm interested in hearing, part of the PREVENTS is to establish this roadmap. You've been getting a lot of input, like you said, from a wide range of people. So I'd like to hear more about the roadmap aspect.

Dr. Van Dahlen: (15:48) So this will literally we're, we're constructing it and putting it together now it, it will be delivered to the president's desk on March 5th. Like a journey, you know, this is really a plan, how do we get from here to there? And there are several pieces of this journey that, you know, we need to be focused on. One is the big public health effort that we were just talking about. What does that look like? So creating a national campaign that will be very similar to big campaigns that we've seen that have made huge impact on our culture. Things like friends, don't let friends drive drunk, buckle up for safety. These kinds of calls to action that are very easy for people to get. So a lot of the big public health piece that's part of this roadmap, part of the plan.

Dr. Van Dahlen: (16:41) Building this research ecosystem. How do we partner both inter-agency partnerships, which, people may assume…or maybe they don't…no, they probably don't. They may assume that agencies work easily together and it's not because agencies necessarily don't want to. It's just, it's challenging. It's difficult. So part of this work is going to be intentionally focused on inter- agency collaboration. Another piece of the roadmap will focus on workplace and professional development. We want to make sure that our corporations are ensuring programs are adopted that focus on emotional health and wellbeing. Again, public health, we want to make sure that it's about everyone so that when people are struggling, veterans are struggling, those veterans who are in the workforce, who the VA doesn't touch, we want to make sure that their companies are supporting not only them, but their entire workforce. And oh, by the way, we believe that our veterans will lead the way we were already seeing it.

Dr. Van Dahlen: (17:36) We're already talking to many of our veterans service organization partners. They're excited because once again, we need those who have served to continue to serve in this way for each other and for the broader community. So the workplace, that's an important area of focus. We're also talking about safety. Safety around lethal means because we know that access to lethal means increases suicide. We know that. And so this is one of the areas that some people are understandably concerned about, you know, they're worried about, is this only about gun restriction? The answer is no, it's not. It's about safety. We all, we know that things like trigger locks, gun safes, saves having voluntary storage of weapons when people are at high risk. We know that looking at bridges and how do we ensure that we are smart around bridges. There've been good studies that have found that if there's a bridge in a community that people are, are jumping from and you put up barriers and nets that they don't go to other bridges.

Dr. Van Dahlen: (18:39) I mean, it's just interesting what we've learned about how people make these decisions. So that safety issue is critical. And then partnerships, you know, we are building a huge number of partnerships because we can't do this alone, even though PREVENTS, has access to a massive a number of potential partners, again within government, outside of government. But we also want to ensure that wherever possible we can facilitate other partnerships that grow efforts in communities. And then finally the community work. Eventually, we are crafting a proposal…we're not in the work of, my office is not in the work of lobbying for any specific legislation…we were tasked with creating a proposal that is a standard that can be held up to say, this is what legislation can look like, that will help drive funding into communities to support this type of work. So you'll have, you know, how we start out on this journey. You'll see the big public health campaign, some of these partnerships, the research ecosystem being built, the grant funding, starting to get finalized and flowing. And lots and lots and lots of convenings and gatherings and elevating and amplifying as we work to change the culture of our country, which is a big task, but very doable.

Duane France:  (20:00) I agree. And again, you had mentioned it before that if everything that everyone was doing individually would solve the problem, the problem would be solved by now. And so I think that right now there is this national effort. There's more awareness. Really applaud your efforts. I appreciate your participation and obviously your continued service because that's really what this is about is it's not another effort just to do stuff, and then, like you said, just sit on a shelf somewhere.

Dr. Van Dahlen: (20:31) Absolutely. And a couple of things if I might, Duane, to close, one of the things I didn't mention, but I'd like to also note our office and, and, and I have been out in communities already. We visited in Texas. We were in Arizona just last weekend. I was in Tennessee, Johnson city, Tennessee doing great work. We're, we're on the road, we're doing town halls. We're asking people to come together. And that's really key too that people understand. We are looking, we want to make sure that we are, we're working with tribal communities. That's partly why we were out in Arizona. At some point I'll be up in Alaska visiting, you know, we, we see this as this, this opportunity to save lives to improve emotional health and wellbeing. And I guess what I'd like to leave with or close with: two thoughts that I hope are helpful to people and one of these, I actually took from a good friend who's a very smart epidemiologist at Harvard who said, you know, it takes about 30 things to go wrong for someone to die by suicide.

Dr. Van Dahlen: (21:41) So many things have to go wrong. It isn't just one thing. You mentioned, you know, preparing for storms. It really is not to overuse the phrase, but it is an ugly, horrible storm, perfect storm of things that go wrong that lead to that decision. Sometimes it's an impulsive act, but sometimes it is a series of things that that end with that final decision. What that means is if one of those things goes right, if somebody intervenes with one of those things, you can literally change someone's life. And finally, I think the most important thing that we can each do is push ourselves to be more open and authentic with people we care about, about our own struggles and what works for us. If we do that, if we in increase just the basic communication about these things, you open the door that could save someone's life. Thank you so much for bringing this to your audience and for all you do to ensure that those who serve their families, our veterans have a program like this to hear about these relevant topics, so thank you.

Duane France:  (22:52) Yes, absolutely. Thank you.

Duane France:  (23:01) It was great to talk to Barbara. As she mentioned she had been on Headspace and Timing Podcast and she and I had talked quite a bit in the past, but it was great to be able to get her point of view on the PREVENTS initiative. What did you think about what we talked about?

Shauna Springer: (23:16) I thought it was a great conversation to really frame out, you know, what is to come in terms of not only the work of the task force but what we're going to be focusing on for this podcast. I really liked the analogy, you seem to really like it as well, of the needle in the haystack. As she describes these concrete aims of the task force, she talked about how messaging and interventions within corporations need to be part of this public health approach. And I think this is critical. One of my most fulfilling training experiences in the past couple of years was to develop and film for broad dissemination, a suicide prevention training for a civilian corporation that hires a large number of veterans as well as many, many civilians. They have a workforce of 20,000 people. And doing that training for all of them all at once really hit a cross section of individuals. And this was the haystack that Barbara refers to here. And after that training, the veterans in the group said felt really good for them not to be singled out for this kind of extra suicide prevention training, but to be included as everyone else in the workforce was. So I think this conversation about corporations is going to be critical to changing the culture of the country as far as Barbara put it. What do you think Duane?

Duane France:  (24:39) Yeah. You know, I definitely agree with that. The idea that, you know, we don't want to be singled out. We don't eat, you know, we just want to put our head down and go to work. Right? I mean, we don't want to be seen as one of those weird veterans in the workplace or so on. Which, really, again, is sort of the struggle of, we have this entire show, we're going to be talking about this this entire year focusing on this. And so it's a critical aspect to yes, focus on the unique cultural aspects of military when it comes to suicide. But I think you're right. It's also important to wrap that into the larger conversation.

Shauna Springer: (25:15) Yeah. And I really loved how she talked about suicide is not just an issue for those who serve in the military. You and I both agree, you know, it's a society wide issue. In my work I've definitely emphasized how we shouldn't underestimate how insidious suicidal thoughts can be given that some of our strongest, bravest citizens are dying by suicide. And I really appreciated how Barbara put it when she said that we all have risk factors for suicide. By explaining it in this way. Barbara is effectively stating that suffering is a human universal and at the same time, you know, the nature of what drives a particular person to despair is going to vary a little bit depending on who they are. So I think if we really integrate this understanding, we'll approach others suffering with that necessary measure of humility and shared compassion. And I know that you and I agree on this general approach. How do you emphasize this message in the work you do with those you serve?

Duane France:  (26:18) Well, one of the things that, I often tell people and, and we've meant, we've talked about it before is that something actually the Dr. Phillip Smith of the University of South Alabama had mentioned on the other show was how suicides both common and rare. And that it's common in that all of us know someone who has maybe lost their lives or been impacted by suicide, but it's that we can go many years without experiencing that. But when I started talking about this, one of the first things I remembered was the first funeral I ever went to, I was maybe 9 or 10 years old, and it was to a cousin who had taken his own life and he wasn't in the military. Right? So it's one of these things that it's just this long-term you know, it's pervasive in everybody's life.

Duane France:  (27:06) And, and like you said, it's common. The other thing that she was talking about made me think about was these, these risk factors. And I didn't bring it up in the interview, Ernest Hemingway. He had all of the risk factors, right? He was exposed to trauma, he had a substance use disorder, had depression, all of these different, you know, I mean, and if back then, whether Hemingway would have, you know, done anything about it or not, but I see that as a classic case of all of the risk factors right there. And it ended the way that it ended.

Shauna Springer: (27:41) Yeah. I mean, I remember being in high school and we had this beloved science teacher who was young and good looking. And two weeks before he died by suicide, he was actually the winner of what we called the Turkey trot, which was a cross country race that all the faculty from different schools in our division would race each other in this big event. And all their kids would come out and watch. And so everybody was cheering for him and he was just vibrant and full of health. And a favorite teacher among so many kids. Engaged to be married and he died by suicide and nobody, you know, saw it coming. And so we were called into this assembly and his fiancé was there, you know, grief stricken and it was such a shocking kind of way to be introduced to the idea that some of the people that you definitely wouldn't see or wouldn't expect to be suffering in that way can be. And so I really think it's important to realize that and really loved the way that this conversation flowed with Barbara and the thought that we all have potentially risk factors for suicide. I think that brings us to a place of humility, which is very helpful for the conversation.

Duane France: (28:56) Yeah, I think this was a great conversation with Barbara. I'm definitely looking forward to seeing what the prevents task force comes out with because this is something I think that has been needed at the national level is really sort of, again, what we're trying to do here just to broadcast. But I think that they're going to be doing some very good work.

Shauna Springer: (29:17) Yup. Very interested in seeing how it all unfolds.

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