Innovative Chaplain Training in Suicide Prevention - VA Pittsburgh Healthcare System
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Innovative Chaplain Training in Suicide Prevention

Female actor plays the part of a distraught transgender Veteran.

Actor Stacie Backauskas, left, plays the part of a distraught transgender Veteran as Chaplain Katie Maul, seated, works to calm her.

By Keith Gottschalk
Monday, August 13, 2018

A desperate Veteran makes a phone call from his garage to a Department of Veterans Affairs chaplain. Voice shaking, he tells the chaplain he is estranged from his loved ones because of his behavior.

"I think everyone would be better without me," says the Veteran, crying.

The chaplain asks the Veteran if he has access to weapons or other means to harm himself.

Following a short pause, the Veteran coolly replies, "As a matter of fact, I'm holding a pistol to my head right now."

If you were the chaplain, what would you do?

The chaplain who took the Veteran's phone call, Tracy Lostaunau, calmed the Veteran, empathized with his situation and arranged for a family member or friend to sit with the man until help arrived.

Lostaunau's actions might have saved the Veteran's life, had the phone call been real. Although the tense scenario that played out recently at VA Pittsburgh Healthcare System was only a simulation, the scenario occurs far too often in real life. Twenty Veterans die each day of suicide. Of those, six are enrolled in VA care, with half receiving mental health services. VA estimates 18 percent of all U.S. adult deaths by suicide annually are Veterans. As many as 25 percent of Veterans have a history of previous suicide attempts, and 764 who are in VA care attempt suicide each month.

To better prepare chaplains to help Veterans who are having thoughts of suicide, VA Pittsburgh is piloting a new suicide awareness training program developed by Chaplain Gretchen Hulse. Lostaunau was one of approximately 20 chaplains and chaplain residents who participated in a July 19 training session at VA Pittsburgh's University Drive campus in Oakland. Participants ran through five scenarios, with actors from the University of Pittsburgh's Standardized Patient Program portraying Veterans in crisis.

Hulse's new training, which she calls "experience training," has already caught the attention of VA's Office of Mental Health and Suicide Prevention and its National Chaplain Center.

"They had never heard of progressive training like this for chaplains, and they are interested in it going nationwide," said Hulse, a VA Pittsburgh chaplain since 2012.

Hulse will include the July 19 training session in program proposals for VA Pittsburgh and a national pilot.

But all of that is in the future. VA chaplains are keenly aware Veterans in crisis can reach out for help at anytime, anywhere. Fortunately for those who participated in Hulse's training, the Pitt actors – most have theater or performance backgrounds—were frighteningly convincing.

In the fifth and final scenario, actor Stacie Backauskas played 'Melanie,' a transgender woman in crisis. A doctor and an alcoholic who was just fired from her job at an addiction clinic, Melanie now faced homelessness. She held a bottle of pills and sobbed loudly in a common area of a VA hospital.

It was up to Chaplain Katie Maul to quickly sift through the many layers of Melanie's crisis, earn her trust and get her to a place that would help her.

Maul gently coaxed Melanie into talking about her problems. The she told Melanie that God loves her.

Was it a mistake?

"How can I have faith in a God that hates me," Melanie cried. "Why did God put me in the wrong (expletive) body?"

But it wasn't a mistake—getting such difficult issues out into the open allows chaplains to address them.

Backauskas was impressed.

"You got me to say all of the things that were in my head rather than focus on one thing," she said.

Other scenarios focused on a variety of situations to help teach chaplains to navigate a crisis safely and effectively. Learners were active participants in clinical simulation scenarios as well as an observer of others' experience. Each person assessed their own performance and/or the performance of fellow learners in identifying what was done well and providing feedback to the learner.  An in-depth facilitator-led debriefing of the entire event was conducted following all scenarios.

Hulse developed the experiential training for chaplains, who are often on the front line in the fight against suicide, as a companion to the current online, passive learning model that often leaves chaplains ill prepared for real life situations. She was even more hopeful for the success of her proposed national pilot program after witnessing the chaplains in action.

"I wasn't really sure what to expect," said Hulse. "I'm so honored to have the folks from Pitt make the scenarios come alive, and so proud of our chaplains who were able to make themselves emotionally available to the actors playing Veterans in these scenarios."

VA Pittsburgh's chaplains can be reached at 412-822-1551. Veterans in crisis or family members or friends of Veterans in crisis can also call the Veterans Crisis Line at 1-800-273-8255 and press 1.

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