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Recent Apparent Suicides Highlight Need for Post-Violence Recovery Plans

Three apparent suicides that occurred in late March reaffirmed the need for post-incident plans that address long-term trauma in the aftermath of workplace violence and mass shootings.

All three decedents had either survived a school shooting or had been related to a victim. Two youths who survived the Marjory Stoneman Douglas High School shooting in Parkland, Florida died by apparent suicide just 13 months after a former student killed 17 and injured several more. Shortly after, it was reported that the father of a child killed in the 2012 Sandy Hook Massacre–in which a gunman killed 26 children and adults in a Connecticut elementary school–allegedly died by suicide.

As of March 31, 2019, the Gun Violence Archive confirmed 68 mass shootings for the year, and with statistics sure to rise, companies and institutions should be mindful of the delayed effects of workplace violence. Risk Management Monitor previously reported the number of suicides in the United States has risen in nearly every state between 1999 and 2016. Employers may use these tragedies to reconsider their own prevention and awareness efforts, and ways they can productively contribute to the dialogue and keep their workers safe.

Paul Marshall, managing director of Active Shooter and Workplace Violence at McGowan Program Administrators said post-incident trauma counseling is critical when it comes to preventing or reducing long-term effects.

“The trauma counseling for the mental anguish needs to be aggressively pushed, almost like the way post-traumatic stress disorder is for first responders,” Marshall said.

Counseling for physical and non-physical injury survivors and witnesses is something that could be missed when drafting a premises or employer liability policies, he said. In fact, Risk Management magazine reported that companies may not be aware of potential gaps in their coverage or that the limits of their coverage, when considering active shooter incidents, are insufficient.

Marshall said that instead of a duty to defend when it comes to a commercial general liability policy, insurers can address long-term trauma with a duty of care clause. This, he said, demonstrates an employer’s willingness to help victims from the outset.

“There’s a typically a year limit on these policies – in the insurance industry you need to apply some sort of time limit,” Marshall said. “But it’s still a year longer than you’d otherwise get. And there has been a huge uptick in these policies from a year ago.”

#BeThe1To is the National Suicide Prevention Lifeline’s campaign to empower people to help those in crisis.

How Employers Can Help

Addressing post-incident trauma in an insurance policy is important, but equally paramount is the need to ensure that employers make training available for affected employees – regardless of where the incident occurred. Regina Phelps, president of Emergency Management & Safety Solutions, said that post-incident crisis management protocols should be added to workplace violence preparedness plans. Therapy and grief counseling are critical details of those protocols.

“Always give co-workers the option of attending any funeral or memorial service for the victims,” Phelps said. “Be aware of employees’ feelings of guilt – some might feel that they could have done something to stop the suicide or perhaps the victim told them of their plans, and they dismissed the comments. Incidents like that will make co-workers feel like it is their fault. Engage your employee assistance program [EAP] to provide education and training about the suicide threat and the complexities of the situation. If appropriate, support employees who start a tribute or fund to support the worker’s family.”

Phelps said that regular post-incident training can be just as crucial as prevention.

“It is essential to conduct regular exercises with the individuals responsible for the plan and its implementation. This could include the organization’s crisis management team as well as key departments such as human resources, security, facilities and communications,” Phelps said. “Plans are written in a vacuum. During most incidents, plans are not pulled out and people instead operate on muscle memory.  Exercises are the best way to ensure that the muscle memory will be helpful.”

Finally, Phelps stressed that employers communicate that their EAPs are typically available to employees’ families as well.

“Providing mental health services to employees and their families is essential,” she said. “The incident will affect not only the employee but their families. Ensure that counseling services are very convenient – offering an option at work, off-site as well as virtually is essential to make sure that employees get the help that they need. It is also critical to provide these same services to their immediate family.”

For more about active shooter preparedness, RIMS members can access a new professional report, “Active Shooter Preparedness and Your Organization.” To download the report, visit RIMS Risk Knowledge library at www.RIMS.org/RiskKnowledge.

If you or someone you know might be at risk of suicide, here’s how to get help: In the United States, call the National Suicide Prevention Lifeline at 1-800-273-8255. The International Association for Suicide Prevention and Befrienders Worldwide also can provide contact information for crisis centers around the world.

BIAA Hopes to ‘Change Your Mind’ About Brain Injuries

March is Brain Injury Awareness Month in the United States. According to the Brain Injury Association of America (BIAA), at least 5.3 million Americans live with a disability related to a traumatic brain injury (TBI) and with 280,000 attributable hospitalizations and 2.2 million emergency room treatments, the economic cost exceeds $82 billion annually. Furthermore, a staggering 137 people die in the U.S. daily because of TBI-related injuries.

Workers in the construction industry experience a large number of occupational brain injuries, with falls being a major driver. Though the direct link between falls and brain injuries is highly suggestive, data from the Bureau of Labor Statistics (BLS) indicates that fatalities caused by preventable falls from elevation continue to be a leading cause of death for construction employees, accounting for 366 of the 971 construction fatalities recorded in 2017.

According to the BIAA, falls are the leading driver of TBI-related injuries (40.5%), followed by being struck by or against an object (15.5%) and motor vehicle accidents (14.3%).

But there are preventative steps that employers and workers can take to reduce the risk of brain injuries, and BIAA is spreading the word in advance of Brain Injury Awareness Day on March 13 with its Change Your Mind campaign.

“Any employee may slip and fall in the workplace, or something may fall from a shelf and strike an office employee,” Susan H. Connors, BIAA president and CEO told Risk Management Monitor. “Employers should take precautions such as ensuring adequate lighting, moving heavy items to bottom shelves, maintaining handrails in stairs, taping down rugs, even/dry flooring, and making sure steps are brightly marked.”

The day will be marked on Capitol Hill, where a Congressional Brain Injury Task Force will meet to coordinate and support federal resources, grow the force and bolster research. Connors said that as in years past, there will be an awareness fair, congressional briefing, and reception, but employers who cannot attend can still take part by:

  • Contacting their Congressional representative to join the task force.
  • Plan to host an event in March to increase awareness and understanding about brain injury, to remember someone lost to brain injury, or even to celebrate a loved one’s recovery.
  • Download the #ChangeYourMind collateral and distribute among your organization and use the stamp to raise awareness, advocacy, or funds for a brain injury-related cause.

“Identifying, implementing, and enforcing safety or risk management protocol is essential and effective regardless of the industry,” Connors said. “The programs in place likely vary based on the position, but common trends may be requiring safety harnesses, protective wear, regular breaks, and/or safety audits or assessments by more than one (or even two) employees on infrastructure.”

Brain injuries are often causes of depression and even suicidal tendencies, which is why Connors said the BIAA actively works to act as a resource for victims.

“The most dangerous and prone cases are those with a mild brain injury, like concussions, who do not receive treatment and/or do not understand why they are feeling depressed and alone,” Connors said. “Suicidal behavior is enhanced by the presence of depression, impulsivity, hopelessness and chronic pain in the face of TBI.

Providing a more compassionate and user-friendly service delivery model of care to ensure timely care and individualized treatment reduces needless frustration and risk.”

Connors added that BIAA’s National Brain Injury Information Center (NBIIC) is also a resource staffed by brain injury specialists, and the Suicide Prevention hotline is available around the clock for people having thoughts of hurting themselves.

Information on Brain Injury Awareness Month, including educational material and downloadable collateral, is available at www.biausa.org/ChangeYourMind.

Suicide Discussions in the Workplace

Conversations about suicide in the workplace have been seemingly unavoidable, due to the self-inflicted deaths of apparel icon Kate Spade and Anthony Bourdain, chef, author and “Parts Unknown” host, last week. Employers may use these tragedies to reconsider their own prevention and awareness efforts, and ways they can productively contribute to the dialogue and keep their workers safe.

According to the latest Vital Signs report by the Centers for Disease Control and Prevention (CDC) (which was released in the time between the two aforementioned fatalities), suicide is the tenth-leading cause of death in the United States and is on the rise. The new data also shows that in 2016, nearly 45,000 Americans age 10 and older died by suicide—equaling about 123 people every day.

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The increases were reflected in 49 states (Nevada being the only one with a decrease) and 25 states had rate increases of more than 30% since 1999.

“Suicide is a leading cause of death for Americans—and it’s a tragedy for families and communities across the country,” CDC Principal Deputy Director Anne Schuchat, M.

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D. said in a statement. “From individuals and communities to employers and healthcare professionals, everyone can play a role in efforts to help save lives and reverse this troubling rise in suicide.”

Suicide is rarely caused by a single factor, the CDC said. Although suicide prevention efforts largely focus on identifying and providing treatment for people with mental health conditions, there are many additional opportunities for prevention.

Dialogue Etiquette
What we say or don’t say, and how we say it, matters to those struggling with thoughts of ending their lives and to those suffering a loss due to suicide. Suggestions for how to address the issue are offered by CNN, which quoted a crisis intervention expert advocating for changing the phrase “committed suicide.”

“It implies sin or crime” –we “commit” sins and crimes – “and pathologizes those affected. We suggest more objective phrasing, like ‘died by/from suicide,’ ‘ended their life’ or ‘took their life,'” said Dese’Rae Stage, a suicide awareness activist. “If we’re using the right language, if we’re pulling negative connotations from the language, talking about suicide may be easier.”

Ultimately, the CDC suggests that there is no single method that best prevents or reduces suicide. “Rather, suicide prevention is best achieved,” it stated in the technical package, “…across all sectors, private and public.”

Although society’s collective attention span is limited, considering the barrage of headlines emanating from media outlets and overall news fatigue, suicide – like drug use – is a public health concern. It is likely that more stories and facts will emerge in the coming weeks about the CDC’s data, as well as the mindsets of Bourdain and Spade, which will bring the topics into a mainstream dialogue again.
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The Business Impact
In 2017, the CDC released Preventing Suicide, a technical package containing strategies and approaches to help employers, government and other sectors of society take a comprehensive public health approach to prevention and address the range of contributing factors.

The package also explores the health and economic consequences of suicides and suicide attempts. For example:

  • In 2013, suicide cost $50.8 billion in estimated lifetime medical and work-loss costs alone.
  • Another study estimated the total lifetime costs associated with nonfatal injuries and deaths caused by self-directed violence to be approximately $93.5 billion in 2013.
  • One estimate suggested that 13.2 million (7%) of the U.S. adult population knew someone 12 months prior to the study who had died by suicide.

The technical package suggests that businesses are among the entities that “are in the best position to establish policies and support practices that create protective environments where people live, work, and play.”

Strategies in a reduction or prevention effort include:

Strengthening access and delivery of suicide care. Two approaches include adding/increasing coverage of mental health conditions in health insurance policies and reducing provider shortages in underserved areas and providing safer care through changes in the systems. The CDC states: “Equal coverage does not necessarily imply good coverage as health insurance plans vary in the extent to which benefits and services are offered to address various health conditions.

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Rather it helps to ensure that mental health services are covered on par with other health concerns.”

Creating protective environments. This involves fostering a culture characterized by awareness and encourages prosocial behavior (such as asking for help) that should start at the executive level. It also calls for reducing access to lethal means (such as chemicals, weapons and other items that may be available or necessary in the workplace) among those who may be at risk of suicide.

Reducing future and unexpected risks. These include suicide contagion—which can be triggered by continuous, sensationalized or uninformed reporting on the subject. Should your workplace be impacted by a suicide, postvention approaches such as debriefing sessions, counseling and other actions to provide a protective environment can help balance workplace morale and “may reduce survivors’ guilt, feelings of depression, and complicated grief.”

It is worth noting that World Suicide Prevention Day will be observed on Sept. 10, which coincides with National Suicide Prevention Week  (Sept. 9-15) in the U.S.