Suicide in the Military


Stressed by war and long overseas tours, U.S. soldiers killed themselves last year at the highest rate on record, the toll rising for a fourth straight year and even surpassing the suicide rate among comparable civilians. Army leaders said they were doing everything they could think of to curb the deaths and appealed for more mental health professionals to join and help out. Clearly, the military is going above and beyond to try and prevent further lives from being taken.

According to the sociologist Emile Durkheim, when a person has a very strong degree of social connectedness, he or she may identify with its values or causes to such an extent that the sense of his or her own personal identity is diminished. For example, the values of the military predominated over the individual’s values. Such is the case in altruistic suicide, which has been defined as the “the self destruction demanded by a society... as a price for being a member of that society.” (DeSpelder & Strickland).
The highest officer in each service told lawmakers they are working hard to fix the problems — devoting more senior leadership attention, instituting more and better training, attacking the stigma of asking for help, hiring more mental health providers and working across agency lines to keep an eye on and fund care for at-risk troops who transition back to civilian life. The specific steps range from implementing or strengthening “battle buddy” programs to ensure troops look out for each other; embedding, as the Marines have done, more mental health professionals within units; improving the “handoff” from the war zone to providers back home; and ensuring better continuity of care when troops transition from military to VA care, officials said. (Air Force Times, 2009)
This is the first time since the Vietnam War that the rate of suicide in the Army, about 20 deaths per 100,000 soldiers, has surpassed the civilian suicide rate. Last year in the Army alone there were 140 suicides, translating into a rate of 20.2 per 100,000 soldiers. Also, the number of Army suicides increased for the fourth consecutive year, according to the Army’s 2008 Suicide Data report released on January 29, 2009. The Army’s high suicide rate is attributable in large part to deployment stress, Gen. Peter Chiarelli, Army vice chief of staff stated. Long deployments and other factors including job-related difficulties and financial, personal and legal problems are other contributing factors. “A high mission tempo clearly can place strain on a military, and with wars in Iraq and Afghanistan, 12 months or longer deployment rotations and 12 months or less downtime at home, the Army certainly has been busy,” Chiarelli said. The Army found about 35 percent of suicides came after soldiers returned home from deployment, while another 35 percent of suicides occurred among soldiers with no history of deployment. 30 percent occurred while soldiers were in the field.

To help combat the suicide increases, the Army has entered into an unprecedented five-year, $50 million partnership with the National Institute of Mental Health (American Forces Press Service). The purpose of the study is to understand the urgency of the situation, to identify risks and prevention factors, and to develop new and better intervention. The knowledge will benefit both soldiers and families as well as the civilian population.

One of the key issues the Army has been trying to address is the feeling among many soldiers that seeking psychological help is a sign of weakness and could be harmful to their career. Since Oct. 1, an average of three hot line callers per day have identified themselves as being on active duty, said Kathryn Power, director of the Center for Mental Health Services in the Department of Health and Human Services. Sen. Lindsey Graham, R-S.C., said that indicates many conflicted troops continue to feel a sense of stigma over reporting suicidal thoughts to superiors or military mental health officials. “When you’ve got this many people feeling they can’t talk to someone within the system, that’s a problem,” Graham said. “We must eliminate the perceived stigma, shame and dishonor of asking for help,” said Adm. Patrick Walsh, vice chief of naval operations. “This is not simply an issue isolated to the medical community to recognize and resolve...” Such efforts should include keeping an eye on those closest to the suicide victim, said Brian Altman, acting chief operating officer for Suicide Prevention Action Network USA, a Washington-based public policy and advocacy group. (Air Force Times).

The Air Force lost 38 airmen to suicide in 2008, a rate of 11.5 suicides per 100,000 airmen. The average over the past five years — since the start of Operation Iraqi Freedom — was 11 deaths per 100,000 annually. Of the airmen lost in 2008, 95 percent were men and 89 percent were enlisted. Young enlisted men with a rank of E1 to E4 and between the ages of 21 and 25 have the highest risk of suicide. Recently released data indicates that active duty males carry, for the first time in known history, a suicide risk greater than that of comparable males in the general population (Psychotherapy Brown Bag, 2009). This is particularly noteworthy considering that the military entrance process screens out serious mental illness prior to entry onto active duty, and that the rate of suicide in military males has historically been significantly lower than comparable civilian populations. To help prevent and reduce these alarming statistics, military psychologists and mental health professionals have begun research to gain empirical support for a simple model to improve assessment, treatment, and prevention of suicidal behaviors in active duty members.

In a report to Congress, Craig Duehring, assistant secretary of the Air Force for manpower, said, “there does not appear to be a strong correlation between deployments and suicide.” A check of deployment records found that from 2003 to 2008, only 39 Air Force suicide victims had deployed in the previous 12 months. Another 150 had never deployed. A more common indicator of risk was seeking mental health counseling for issues ranging from alcohol abuse to marriage counseling, Duehring’s report said. Fifty-five percent of airmen who killed themselves had attended counseling sessions (Air Force Times, 2009). Other factors in the Air Force suicide rate include relationships gone awry and poor communication between the treating mental health providers and commanders. There is always tension in the military between confidentiality and the need to communicate with supervisors. This is now being addressed so that soldiers can discuss personal issues without being worried about facing discharge.

The Navy’s suicide rate has remained roughly steady over the past four years, but suicide ranks as the service’s third-leading cause of death, said Walsh. The Navy reported 41 suicides in 2008, a rate of 11.6 per 100,000. About 39 percent of the sailors who committed suicide last year were facing disciplinary action, he added. Financial issues were also a factor, said Master Chief Petty Officer of the Navy Rick West. West added that the Navy has been setting up support programs such as operational stress control, and has also vamped up its financial counseling programs.

The Marine Corps lost 41 Marines last year to confirmed or suspected suicides — up from 25 two years earlier — a rate of 19 per 100,000. General James F. Amos, USMC, Assistant Commandant of the Marine Corps, said the most likely Marine to die by suicide is a Caucasian male, 18 to 24 years old, between the ranks of private and sergeant. The most likely cause is a failed relationship with a woman.

Active duty military members aren’t the only ones who are affected by suicide. According to Dr. Thomas Insel, the director of the National Institute of Mental Health in Bethesda, Maryland, post-war suicides may outnumber deaths from combat. In the aftermath of war, many experience symptoms such as numbness, irritability, depression, difficulties in relationships, and guilt at surviving when others did not. The term posttraumatic stress disorder (PTSD) has been used to describe such symptoms, although such reactions have also been termed “delayed grief syndrome” or posttraumatic grief disorder.” (DeSpelder & Strickland, 2005) People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life. The two main forms of post combat mental illness include PTSD and depression, both of which are cited most often as causes of suicides by returning soldiers. Among additional factors related to the suicide rates are personal, marital and family problems, repeated and extended deployments, extended periods of hard combat and even undiagnosed preexisting mental disorders. The military has stated that at least one in five American soldiers who were deployed overseas to Iraq or Afghanistan suffer from some degree of PTSD.

Army officials have been committed to finding out why more soldiers committed suicide in 2008 than ever recorded. “It’s a national problem... we’re committed to doing everything we can to address (the issues) better and (and) put programs in place,” said Army Secretary Pete Geren. The Army is using a variety of short- and long-term programs. One of those is the Strong Bonds program. Strong Bonds has specialized programs for single Soldiers, couples and families. Those Soldiers being deployed or redeployed can also learn special coping tactics. Strong Bonds empowers Soldiers and their loved ones with relationship-building skills, and connects them to community health and support resources. It is a holistic, preventative program committed to the restoration and preservation of Army families, even those near crisis. The program is initiated and led by the Army Chaplains. More than 90% of those who have attended the program rate it positively. Another program recently launched is called Battlemind. The objective of Battlemind is to reduce combat stress reactions. The staggering statistics of combat are eye-opening: 65% of deployed soldiers have have seen a dead or seriously injured American, 50% have had to handle or uncover human remains, 48% are responsible for the death of an enemy combatant, and 21% have had to save the life of a Soldier or civilian. Combat leaves haunting memories. After the shooting stops, the mind must “sort out and file the almost incomprehensible facts of war” (DeSpelder & Strickland).

The Air Force has aggressively pursued increasing community awareness of suicide risks and available services and decreasing the stigma surrounding accessing mental health services. Senior Air Force staff reinforce the perspective that suicide prevention is a community effort and regularly distribute notices to personnel regarding the problem of suicide within the Air Force (USAFMS, 2000). Regular staff development courses have also now incorporated suicide prevention education for all officers. Such training describes the risk and protective factors for suicide, including contexts and symptoms of acute suicide risk, and when and to whom to refer individuals at risk of suicide. Enhancing the mental well-being of the entire unit is conveyed as each staff member’s responsibility. Supervisors and unit members alike are encouraged to persuade those facing mental health issues (including substance abuse and domestic violence) to self-refer to counseling. The Air Force presents such actions as a means of increasing unit productivity and helping the individual reach his or her fullest potential, and explicitly states these goals as motivation for commander-directed mental health evaluations when individuals do not self-refer (USAFMS, 2000). Further, the Air Force has implemented suicide awareness training for staff, changed certain Air Force policies in response to epidemiological research, and developed a database for collecting a broad array of information regarding suicide attempts and completions throughout Air Force personnel and their families.

Clearly military suicide numbers are rising at an alarming rate, but I believe the military is doing all it can to reverse this disturbing trend. Some people wonder why we should care so much about military suicides compared to civilian ones. Service members go to war because we ask, or rather demand, that they do so. We owe them our best effort to make them as whole as they can be. I care about members of the military because they're serving their country by doing difficult and dangerous work for small tangible reward. For that, they deserve the best of medical care, including mental health care, and if something about their current situation is causing a significant increase in depression, that needs to be investigated and dealt with.

REFERENCES

Carden, M.J. (2009, January 29). Army Works to Combat Rising Suicide. Retrieved from http://www.defenselink.mil/utility/printitem.aspx?print=http://www.defenselink.mil/news/newsarticle.aspx?id=52879

DeSpelder, L.A., & Strickland, A.E. (2005). The last dance. Boston: McGraw-Hill.

McMichael, W.H. (2009, March 23). Suicide rates remain high. Retrieved from http://www.airforcetimes.com/news/2009/03/airforce_suicide_032309w/

Morrow, C. (2009, September 1). Suicide in active duty military personnel. Retrieved from http://www.psychotherapybrownbag.com/psychotherapy_brown_bag_a/2009/09/suicide-in-active-duty-military-personnel-the-september-2009-psychotherapy-brown-bag-featured-articl.html

Ritchey, J. (2009, February 09). US military suicide on the increase. Retrieved from http://www.speroforum.com/a/18082/US-military-suicide-on-the-increase
SUICIDE IN THE MILITARY 1

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