RESOURCES FOR AT-RISK VETERANS AND THE PRACTICING BAR: THE SUICIDE EPIDEMIC CLE Credit: 1.0 Sponsor: KBA Military Law Committee and KYLAP Wednesday, June 12, 2019 11:50 a.m. – 12:50 p.m. Carroll-Ford Galt House Hotel Louisville, Kentucky A NOTE CONCERNING THE PROGRAM MATERIALS The materials included in this Kentucky Bar Association Continuing Legal Education handbook are intended to provide current and accurate information about the subject matter covered. No representation or warranty is made concerning the application of the legal or other principles discussed by the instructors to any specific fact situation, nor is any prediction made concerning how any particular judge or jury will interpret or apply such principles. The proper interpretation or application of the principles discussed is a matter for the considered judgement pf the induvial legal practitioner. The faculty and staff of this Kentucky Bar Association CLE program disclaim liability therefore. Attorneys using these materials, or information otherwise conveyed during the program in dealing with a specific legal matter have a duty to research the original and current sources of authority. Printed by: Evolution Creative Solutions 7107 Shona Drive Cincinnati, Ohio 45237 Kentucky Bar Association TABLE OF CONTENTS The Presenters ................................................................................................................. i Untreated Depression and the Risk of Suicide Among Lawyers and Veterans Who are Lawyers ............................................................ 1 At Risk Veterans: The Suicide Epidemic ....................................................................... 21 THE PRESENTERS P. Yvette Hourigan Kentucky Bar Association Frankfort, Kentucky 40601 (502) 226-9373 [email protected] YVETTE HOURIGAN is the director of the Kentucky Lawyer Assistance Program (KYLAP). KYLAP provides assistance to all Kentucky law students, lawyers and judges with mental health issues and impairments including depression, substance or alcohol addictions, process addictions and chronic anxiety disorders. Ms. Hourigan is a graduate of the University of Kentucky College of Law and practiced law in Lexington in all areas of civil litigation including plaintiff’s personal injury work before being appointed as the KYLAP director. She is credentialed as a Certified Employee Assistance Professional, an Adult Peer Support Specialist, and is a QPR-trained Gatekeeper for suicide prevention. Ms. Hourigan is a member of the ABA Commission on Lawyer Assistance Programs, Chair of the ABA/COLAP Diversity & Inclusion Committee, and a member of the National Task Force on Lawyer Well-Being. In 2014, she was awarded the Dave Nee Foundation’s Uncommon Counselor Award which is given to a member of the legal profession who exhibits “extraordinary compassion and concern for co-workers, family, friends, and community.” Ms. Hourigan speaks locally and nationally on topics impacting lawyer well- being, addiction and suicide prevention. She shares her personal experiences as lawyer, employee assistance professional, and recovering person. Dennis W. Shepherd Kentucky Department of Veterans Affairs 111 B Louisville Road Frankfort, Kentucky 40601 (859) 552-0983 [email protected] DENNIS SHEPHERD is General Counsel for the Kentucky Department of Veterans Affairs in Frankfort. Mr. Shepherd earned his undergraduate degree from the University of Kentucky, his J.D. from the University of Kentucky College of Law, and his LL.M. from George Washington University. i ii UNTREATED DEPRESSION AND THE RISK OF SUICIDE AMONG LAWYERS AND VETERANS WHO ARE LAWYERS Yvette Hourigan, KYLAP I. INTRODUCTION The purpose of this program is to educate lawyers about depression, the severity of the problem here in Kentucky, and how untreated depression may lead to suicide. We hope this information will encourage those who are suffering from anxiety and/or depression, and who may be at risk for suicide, to seek help; as well as to educate Kentucky Bar members how to identify warning signs among our colleagues and our clients and be willing to explore ways we can offer assistance. Depression rates in the Appalachian region of the United States have historically been high. According to a 2016 study focusing on the Appalachian region of the United States, things seem to be depressing in more ways than one for its inhabitants. According to a July 2018 USA Today report, Kentucky is the sixth most miserable place to live in the country. According to their research, we have the second lowest job satisfaction rating (that is, 70 percent express job dissatisfaction), we have the third worst health in the country (with the highest percentage of smokers at 25 percent of adults), and we are the fourth poorest state (the fourth highest poverty rate). In this study and in numerous others, Kentucky is always in the top five most depressed states; is always in the top three in rates of addiction and is now in the top states in overdose deaths. In 2018 there were 1,468 overdose deaths. On average, people with depression go for nearly a decade before receiving treatment. Id. It is likely that lawyers go much longer without seeking help than the average person does, since lawyers seem to have a greater concern about the stigma of treating mental health issues. In fact, a recent ABA/COLAP study indicates that the stigma associated with getting mental health assistance is the greatest barrier to treatment for the legal population. The 2 most common barriers were the same for both groups: not wanting others to find out they needed help (50.6 percent and 25.7 percent for the treatment and nontreatment groups, respectively), and concerns regarding privacy or confidentiality (44.2 percent and 23.4 percent for the groups, respectively). Krill, Johnson, Albers, J Addict Med 2016;10: 46–52. As lawyers, we have a belief, perhaps it’s even subconscious, that because we are paid to solve the problems of others, we must be able to solve our own problems, including our mental health problems. This is, of course, false. There is a saying in mental health that “a sick brain can’t fix a sick brain.” We frequently hear lawyers saying, “I thought I could think my way out of it,” or “I thought it would pass.” Unfortunately, most mental health problems, and particularly a major depressive episode, do not spontaneously repair themselves. 1 II. SITUATIONAL DEPRESSION V. CLINICAL DEPRESSION There are two very general types of depression. Everyone feels sadness during certain times, events, or under certain circumstances. This is referred to as situational depression. But clinical depression is a far more serious mental health condition that can have profound and even deadly impacts on a person’s life. Situational depression is quite common. The medical diagnosis is adjustment disorder with depressed mood. Situational depression is a short-term form of depression that results after a traumatic event or significant life change (or a string of life changes). Triggers can include: • Divorce • Empty nest (when the last child leaves home) • Loss of a job • Death of a close friend • Serious accident • Retirement The depression that occurs is the struggle and difficulty in coming to terms with the dramatic life changes. Some of the symptoms of a situational depression can include: • Listlessness • Feelings of hopelessness and sadness • Sleeping difficulties • Frequent episodes of crying • Unfocused anxiety and worry • Loss of concentration • Withdrawal from normal activities, families and/or friends Situational depression usually occurs within 90 days of the triggering event. It’s a natural response to a traumatic event. It will usually resolve: • As time passes after the stressful situation or event • As the situation improves • When the person recovers from the life event 2 As stated before, it’s only short-term. Mild cases of situational depression will often resolve without active treatment. Lifestyle changes, including exercise, a well- balanced diet, good sleep hygiene, interaction with family and friends, can all help with easing a situational depression. Compare that with clinical depression or Major Depressive Disorder (MDE) which can develop when an individual does not recover from a depression. This is the more severe and serious mental health condition that requires medical treatment. Clinical depression is severe enough to interfere with a person’s daily functioning. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) classifies clinical depression or Major Depressive Disorder (MDE), as a mood disorder. Depression can alter a person’s thought processes and bodily functions. Disturbances in levels of brain chemicals – neurotransmitters – are thought to be at the root of it. But other factors play a role, too, and we’re just learning of the impact of the following situations: • Genetic factors may influence an individual’s response to an experience or event; • Major life events can trigger negative emotions, such as anger, disappointment, or frustration; • Alcohol and drug dependence have direct links to depression. The DSM-5 outlines the following criteria to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same two-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. • Depressed mood most of the day, nearly every day. • Markedly diminished interest or pleasure in all, or almost all, activities most