March 18, 2024
Toolkit

Looking after yourself and others: A resource for Veteran Families

Centre for Suicide Prevention and Atlas Institute for Veterans and Families

This resource is part of a suite of Military and RCMP Veteran and Family suicide prevention resources, done in collaboration with Atlas Institute for Veterans and Families.
Other resources:

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Introduction

Preventing suicide and promoting mental health among Canadian Armed Forces (CAF) and Royal Canadian Mounted Police (RCMP) Veterans and Veteran Family members is vital. Family members may have experienced a suicide loss. They may also know or support a Veteran living with suicidal thoughts or who has attempted suicide. In addition, Family members may be at greater risk for suicide themselves, particularly if they’ve experienced a suicide loss or attempt.[1]

This toolkit, which is for Family members and friends of Veterans, is a companion to the military and RCMP Veterans suicide prevention toolkit. In this resource, the word “Family” refers to partners and spouses, siblings, children, parents or guardians, peers and friends.

This resource is a collaboration between the Atlas Institute for Veterans and Families and Centre for Suicide Prevention. In addition to being informed by research, this toolkit was informed by an advisory committee, including CAF and RCMP Veterans and Veteran Family members.

What to expect from this toolkit

As a Veteran Family member, you may want to learn more about the issue of suicide and ways that you can help reduce risk. You may also want to learn how to look after yourself and your own needs.

Information included in this toolkit can help you:

  • Understand about the impact suicide has on Families
  • Discover tools and strategies to look after your own wellbeing as a Family member
  • Learn how to talk about suicide
  • Identify what role you could play in supporting your loved one
  • Discover useful coping tools and strategies

This resource may not be suitable for you if you’re considering suicide. If you’re thinking about suicide, call or text the Suicide Crisis Helpline at 988 for immediate support.

The impact of suicide on Families

When a loved one experiences thoughts of suicide or engages in suicidal actions, this can have a huge impact on the Family. You may feel a whole host of emotions including hopelessness, fear, and anger. It can also create immense pain and lead to feelings of shame and guilt. However, a person’s suicidality is never your fault or responsibility to prevent – you’re not to blame.

Supporting someone who is experiencing suicidal thoughts or behaviours can feel exhausting at times, even if it’s a friend or Family member. It can take a lot of energy and strength to support someone you love.

For these, and other reasons, Veteran Family members often face tremendous stress, and may even consider suicide themselves. Ensuring you maintain your own wellbeing first is important, otherwise, you may be more likely to experience feelings of isolation, depression, and anxiety.[2],[3]

Here are some ways that Family members may be affected by their loved one’s suicidality:

  • Vulnerable to burnout, fatigue, trauma.[4]
  • Risk of suicidal behaviours themselves.[5]
  • Exposure to stigma, including feelings of blame, which can be harmful for wellbeing.[3]
  • In a healthcare setting, Family members may not receive all information about a Veteran’s treatment and mental state, and they may not be allowed to be involved in their care.[6] This lack of involvement in care or access to information may contribute to feelings of isolation, confusion, or helplessness among Family members.

How Veteran Family members can look after themselves

It is important to recognize and respect your own limits, energy and boundaries. Looking after yourself by engaging with self-care needs to be your priority. Aside from the benefit of maintaining your own mental health and wellbeing, self-care also lessens the negative impacts of caring for others (known as compassion fatigue and burnout) and can encourage personal growth.[7]

Maintaining your mental health and engaging in self-care can look different for everyone and can include any activity you find relaxing or enjoyable. Addressing both physical and mental health is important.

Here are some ideas for self-care:[8]

  • Meditation exercises (e.g., focusing on sensations or sounds)
  • Memory activities (e.g., playing music or memory games)
  • Eating healthy foods
  • Moderate exercise
  • Connecting with friends, family
  • Spending time in nature
  • Doing hobbies or activities you enjoy (e.g., reading, crafting or gardening)

This guide from the US Department of Veterans Affairs provides more detail and examples.

What to do if you’re struggling with your mental health

Part of maintaining your mental health is noticing when it’s beginning to deteriorate. This includes being aware of the situations, events, or circumstances that affect it and your own personal signs that indicate you’re struggling. For example, if you notice you’re not sleeping well or you feel more irritable than usual, your mental health may be suffering, and it’s time to take action to bring it into balance. Rebalancing could involve self-care activities that resonate with you or seeking further support by talking to a Family member, friend or seeing a mental health care provider.

In the transition to post-service life, Family members lose many of the resources and supports they are used to accessing from the Military or RCMP. Finding new resources and supports can be challenging, but it is important.

Here are some resources for Family members who may be affected by a loved one’s suicidality:

The role of Family members

If a Veteran in your Family is experiencing suicidality, you may feel the pressure of being responsible for their wellbeing. You may feel you have no choice but to act as a support person, even if you don’t have the willingness, knowledge, or capacity for such a role.

Your level of support should be based on your own capacity and willingness to help. Your Family member likely needs support, but you don’t have to be the one to provide that support. Remember that it’s okay if you don’t feel like you can support them.

If you’re offering support, you don’t have to do it all alone. Help is available. You can connect them to other resources such as the Suicide Crisis Helpline at 988, community supports at 211.ca, or other Family members or friends.

If you do choose to support them, your support can range from simply connecting them to resources to supporting them more intensively as a caregiver. Learn more about how you can support a Veteran Family member in the Practical Strategies section of this toolkit.

Here are some examples of roles you can take on to support a Veteran Family member:

  • Light involvement: Connector
    In this role, you may connect them to the Suicide Crisis Helpline at 988, Veteran crisis line at 1-800-268-7708, or community resources at 211.ca and encourage them to reach out for help.
  • Medium involvement: Supporter
    In this role, you may check in with them weekly in person or via text (“Hey, how’s it going?”, or “How was work today?”). You may visit them occasionally.
  • High involvement: Caregiver
    In this role, you may live with the person, check in with them frequently, and do things like driving them to appointments or to pick-up medication.

Regardless of what role you play, remember to take time to do something you enjoy, brings you meaning and helps you recharge and de-stress. This can help to avoid burnout or fatigue over time.

How to recognize if someone is thinking about suicide

It’s important to learn how to recognize whether someone might be considering suicide (when possible). Any significant change in behaviour may be a warning sign. Some people may not openly show warning signs, or clues. This can make it difficult for people, even those who care about them, to notice that something is wrong.

Here are some examples of what warning signs can look like:[9]

  • Talking about or making plans for suicide
  • Making statements that indicate hopelessness (e.g., “What’s the point?”)
  • Increasing substance use
  • Withdrawing from friends, Family
  • Raging, having uncontrolled anger
  • Engaging in risk-taking behaviour (e.g., shoplifting, driving dangerously or under the influence)
  • Expressing that they lack a reason for living or have no purpose[10]

Signs may look different from person to person. The presence (or absence) of any of these behaviours does not necessarily mean that a person is (or is not) considering suicide.

How to start a conversation about suicide

This section provides information on how to start a conversation with someone you’re worried about, including examples. You can use these examples as a guide to inform your own conversation. Make sure to tailor the conversation to the person you’re speaking with.

Talking about suicide can be difficult because asking about people’s mental health is seen as “sticking your nose in other people’s business”, even when they are your friends and Family members. However, if you’re worried about someone, it’s crucial to have this sometimes uncomfortable or awkward conversation.

Asking about suicide will not cause suicide. It will also not permanently damage your relationship (though they may be angry or upset at first).

Here is a guide for starting a conversation:

  • Start by mentioning your concerns.
    • “I’ve noticed you’ve been drinking more than usual… that’s not like you. What’s going on with you? Are you safe?”
    • “You haven’t seemed like yourself lately. How are you doing?”
  • Listen to their response. Look out for expressions of hopelessness, melancholy, or desperation:
    • “I feel like I have no sense of purpose anymore.”
    • “I don’t know who I am without my uniform.”
    • “My Family would be better off without me.”
  • If you’re still concerned after hearing their response, explore further. Avoid offering solutions, and instead, be curious to show you’re listening without judgment. Ask them about their situation or feelings and give them space to talk. Silence is okay.
    • “I can tell this is difficult for you. I’m here to listen if you want to talk.”
    • “I’m going to help get you connected to resources to get you started.”
    • “I don’t have a lot of experience in helping someone through what you’re going through right now, but I am willing to get you connected to others who will be able to help you.”
  • If you’re worried they’re thinking about suicide, ask them directly.
    • “It sounds like you’re going through a lot right now. Sometimes, when people are struggling, they think about suicide. Are you thinking about suicide?”
  • If they say yes, give them the crisis line number and offer to make the call together.
    • “There is help available. Here is the number for the Suicide Crisis Helpline (988). We can call them together if you’d like?”
  • If they have imminent plans to take their life, call 911 and ensure they are not left alone.
    • In Nunavut: Contact your local RCMP detachment or 1-867-979-1111.
  • If you’d like more information on how to have a conversation with someone, consider taking a workshop, such as the half-day safeTALK: suicide alertness for everyone workshop or the two-day Applied Suicide Intervention Skills Training (ASIST) workshop.

Here is a list of other important things to keep in mind if you are having a conversation about suicide:

  • Make sure the person knows what role you are playing.
    • Are you there to listen and connect? Are you there to check in and support as needed?
  • Be direct.
    • Asking directly (“Are you thinking about suicide?”), instead of saying things like ‘Are you thinking of hurting yourself?’ is important. This makes it clear what you’re talking about. It also takes the burden off them to say ‘suicide’ themselves, which can make it easier for them to open up.
  • Use sensitive and safe language.
    • Using people-first language can help you avoid stigmatizing words or phrases. It also avoids referring to people only through their actions, conditions, or diagnoses. For example, instead of saying “suicidal person”, say “a person with thoughts of suicide”.
    • Using neutral and respectful language can help you avoid inaccurate, inappropriate or outdated words or phrases. For example, avoid “commit” when referring to suicide or referring to an attempt as “unsuccessful” or “failed”.

Practical strategies to support a Veteran Family member

This section covers some practical strategies that you can use to support a loved one before and after a crisis.

You may not feel comfortable or capable to support your Family member in a crisis. You may find the information in this section helpful to inform your decision. You can also lean on other supports such as the Suicide Crisis Helpline (988) or community supports via 211.ca or by calling 211.

If you decide to call either of these supports, let the person on the line know that you have a Veteran Family member who is considering suicide, and you’d like to connect them with further supports. You can call with your Veteran Family member or call by yourself.

If you choose to support a Veteran Family member who is experiencing suicidality, or who has come home after hospitalization for suicidality, there are many ways you can offer support.  

Here are some ways in which you can offer support:

  • If the person is at immediate risk for suicide, call 911 or the Suicide Crisis Helpline at 988, and let them know that you’ve called for additional help.
  • Create a safety plan together. Learn more about safety planning.
  • Ask them what they need from you. Use this information to meet their needs when you are able and based on your capacity.
  • Provide them with a list of resources, which could include the crisis line, a directory of community services, other Family members or friends, or clinicians.
  • Check in with them to ask how they’re doing however often feels appropriate and manageable for you, and in any way, whether that’s in-person, in a text message, or on the phone.
  • Pay attention to their behaviour and watch out for any signs that they may be struggling (refer to warning signs or the safety plan you created together).
  • Consider other ways that you could play a supportive role like driving them to appointments or to pick-up medication as needed.
  • Spend time with them doing activities you both enjoy.
  • Remove or restrict access to as many means of suicide as you can from your home, for example, firearms, closet rods, or medications.[11],[12]

What if they refuse support?

A person experiencing thoughts of suicide or mental health challenges may refuse help. If this happens:

  • Listen to what they have to say and validate their feelings.
  • Ask questions about what they want and resist the urge to give advice.
  • Acknowledge their perspective. They may indicate a preference for one form of help over another, and together, you could explore options.[13]

They may not think there is a problem or feel they can address it on their own. However, if they are in immediate danger of harming themselves or others, call 911 (in Nunavut, contact your local RCMP detachment or dial 1-867-979-1111).[14] Calling 911 might not feel like an easy decision, even in situations where it may be necessary.

What to expect if your loved one is admitted to hospital

The goal of an emergency department is to resolve the suicide crisis, stabilize your loved one, and make recommendations and referrals for follow-up. A physical assessment will be conducted, followed by a mental assessment. Ideally, this is what is supposed to happen – but it is not always the case. Sometimes referrals and follow-ups do not happen.

There is some information you can provide that could be helpful to your Family member’s care team at the hospital.

Let them know if your Veteran Family member has:[15]

  • Access to means of suicide
  • Stopped taking any prescribed medications
  • Hoarded certain medications
  • Stopped seeing their mental health provider (if they have one)
  • Written a suicide note
  • Given away possessions
  • Share any other information you think might be helpful, too

Additional resources

Check out our suite of Military and RCMP Veterans and Family resources:

  • Military and RCMP Veterans and suicide Prevention: A toolkit (includes strategies to reduce risk before a crisis; warning signs, resources for Veterans, Families and communities)
  • Conversation Guide – how to have a conversation with someone, like a Veteran or Veteran Family member, who you’re worried about

Key takeaways

  • Suicide impacts Family members, friends and whole communities. As a Family member, you may be at risk for suicide too.
  • A person’s suicidality is never your fault or responsibility to prevent – you’re not to blame.
  • Looking after your own well-being should be a priority. There are various coping tools and strategies you can use for self-care.
  • You may notice certain warning signs if someone is thinking about suicide. If you’re worried about a loved one, have an open, non-judgmental conversation.
  • You can decide how involved you’d like to be in supporting your loved one, depending on your capacity, comfort and willingness to help.
  • You may need to call 911 or the Suicide Crisis Helpline at 988 if your loved one is at immediate risk for suicide. Your loved one may be admitted to the hospital or they may refuse care. You can support your loved one by asking what they need from you, creating a safety plan, sharing a list of resources and removing or restricting access to means of suicide in your home.

The work of the Atlas Institute for Veterans and Families is made possible thanks to funding from Veterans Affairs Canada.
Disclaimer: Views and opinions expressed are solely those of the Atlas Institute for Veterans and Families and may not reflect the views and opinions of the Government of Canada.

References

[1] Myfanwy Maple, Julie Cerel, Rebecca Sanford, Tania Pearce, and Jack Jordan, “Is Exposure to Suicide Beyond Kin Associated with Risk for Suicidal Behavior? A Systematic Review of the Evidence,” Suicide and Life-Threatening Behavior 47, no.4 (2016), https://doi.org/10.1111/sltb.12308

[2] “The Unique Challenges Facing Caregivers of Veterans,” Trualta, https://www.trualta.com/the-unique-challenges-facing-caregivers-of-veterans-rising-above-and-beyond-the-call-of-duty/

[3] Columba McLaughlin, Iain McGowan, Geroge Kernohan, and Siobhan O’Neill, “The unmet support needs of family members caring for a suicidal person,” Journal of Mental Health 25, no. 3 (2016): 212–216, https://doi.org/10.3109/09638237.2015.1101421

[4] Brian Bride, and Charles Figley, “Secondary trauma and military veteran caregivers,” Smith College Studies in Social Work 79 (2009): 314-329, https://psycnet.apa.org/doi/10.1080/00377310903130357

[5] Myfawny Maple, Rebecca Sanford, Jane Pirkis, Nicola Reavely, and Angela Nicholas. “Exposure to suicide in Australia: A representative random digit dial study,” Journal of Affective Disorders 259 (2019) : 221-227, https://doi.org/10.1016/j.jad.2019.08.050

[6] Valerie Le Moal, Christophe Lemey, Michel Walter, and Sofian Berrouiguet, “Viewpoint: Toward involvement of caregivers in suicide prevention strategies: Ethical issues and perspectives,” Frontiers in Psychology (2018), https://doi.org/10.3389/fpsyg.2018.02457

[7] Charmaine Smit, “Making Self-Care a Priority: Caring for the Carer,” Whitireia Nursing and Health Journal 24 (2017): 29-35.

[8] “VA Caregiver Support Program: Self-Care Activities,” U.S Department of Veterans Affairs, https://www.caregiver.va.gov/Self_Care_Activities.asp

[9] “Warning Signs of Acute Suicide Risk,” American Association of Suicidology, https://suicidology.org/wp-content/uploads/2019/07/Warning-Signs-Flyer.pdf

[10] David Rudd, Alan Berman, Thomas Joiner, Matthew Nock, Morton Silverman, Michael Mandrusiak, Kimberly Van Orden, and Tracy Witte, “Warning signs for suicide: Theory, research and clinical applications,” Suicide and Life-Threatening Behavior 36, no. 3 (2006), https://psycnet.apa.org/doi/10.1521/suli.2006.36.3.255

[11] Michael Kral, and Lori Idlout, “Community wellness and social action in the Canadian Arctic: Collective agency as subjective well-being,” In Healing Traditions: The Mental Health of Aboriginal Peoples in Canada (UBC Press, 2009), 315–336.

[12] “VA suicide prevention toolkit for caregivers,” U.S. Department of Veterans Affairs, https://www.caregiver.va.gov/pdfs/VA-Suicide-Prevention-Toolkit-for-Caregivers.pdf

[13] “What to do when they don’t want help,” Mental Health America, https://screening.mhanational.org/content/what-do-when-they-dont-want-help/

[14] “When a family member chooses not to seek help,” Centre for Addictions and Mental Health, https://www.camh.ca/en/health-info/guides-and-publications/when-a-family-member-is-unwilling-to-seek-help#:~:text=If%20they%20are%20unwilling%20to,crisis%20response%20team%20is%20available

[15] “After an attempt: A guide for taking care of your family member after treatment in the emergency department,” Substance Abuse and Mental Health Services Administration, https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4357eng.pdf