You may remember that I posted a very informative paper written by Julia Dougherty Aten MSW (she is also my mentor) a few months back but unfortunately I had to remove it. I have revised it here because I feel that her research on the data is very important to understand the complexity and the wide spread dilemma associated with suicide in the military and added some information I received from a former Social Worker who conducted the return briefs for Soldiers come back to the states through Joint Base Lewis-McChord, thank you both.
Increasing
numbers of active duty military, reserves, and veterans are committing suicide.
Smith (2011) stated that every 80 minutes, a military veteran will take his or
her life. The problem of military
suicide is at epidemic proportions even though the Department of Defense and/or
the Veterans Administration is not willing to define the current suicide rates
as an epidemic (Smith). Veterans and
active duty military suicides account for 20% of all suicides in the Unites
States even though only 1% of Americans have served or are currently serving in
the military. Suicidal ideation is
associated with depression and PTSD, both of which often go unrecognized within
the military and veteran communities (Smith).
According to Braswell and Kushner (2010), military
suicide is not a new problem. Official statistics from European countries during
the 19th century detailed suicide rates were higher in the military than the
general public. This was a well-known
fact and suicide experts of the time discussed suicide. The first accounts of suicide in the military
date back to Esquirol (1838), who was the leader of the French asylum movement
(Braswell and Kushner).
Problem Overview
Since 2001, the suicide rate among members of our
military has increased exponentially (Braswell and Kushner, 2010). This
increase has continued even with improving behavioral health care for service
members serving in Iraq and Afghanistan.
The outcry in response to the increase in military and veteran suicide
generally blames all the bad things within the military on the stress of
repeated deployments, and the hardships of military life (Braswell and
Kushner). Military analysts link the increase in suicide in the military to the
stress of repeated deployments and combat.
In reality, Pentagon data shows that 70% of service members in the Army
who committed suicide had never deployed or only had deployed one time. The other branches detail comparable
statistics (Braswell and Kushner).
Current Statistics
United
States Army
The US Army began formulating suicide
statistics in 1980 (Zoler, 2012). In
1985, there were 15.8 suicides per 100,000 active duty soldiers. In 2006, the Army surpassed this statistic
with 17.5 suicides per 100,000 active duty soldiers (Zoler). In 2008, the
suicide rate for active duty Army soldiers exceeded the civilian rate for the
first time in history. Since 2008, the
suicide rate has continued to rise. In
2009, 160 active duty soldiers committed suicide. In 2010, 305 active duty Army, National
Guard, and reserve soldiers took their own lives (Zoler).
According to Zoler (2012), in 2011, the Army had the
highest suicide rate in history with 164 confirmed cases of active duty
soldiers committing suicide. This was
the seventh year in a row that suicide rates had steadily increased. For the first three months of 2012 there
appears to be no slowing of suicides within the Army (Department Of Defense,
2012). The DOD reported 45 potential suicides, 20 confirmed suicides, and
another 25 cases still being investigated for active duty army personnel. During the same period in 2011, the Army had
reported 25 cases of potential suicide.
There has been a steady increase in suicides in the National Guard,
especially in the Midwest states (Department Of Defense, 2012). Soldiers in an active duty status and
inactive status committed suicide at the rate of 25 per month in 2010
(Zoler). Suicide doubled within the
National Guard where were in an inactive status during 2010 (Zoler). The increase in suicide rates reported by the
Army among active duty soldiers is not limited to the Army.
United
States Marine Corps
According to the Department Of The Navy (2008), the
Marine Corps started recording and reporting suicide statistics in 2002. There were 26 confirmed suicides in 2003
(Department of the Navy). There were 26
suicides in 2003, and by 2008 there were 42 suicides, and a record 52 suicides
in 2009 (Marine Corps Community Services, 2009). There was a decrease in 2010 to 37 suicides
and in 2011 there were 33 suicides. As
of February 2012 there has been 8 confirmed cases of suicide within the Marine
Corps (Marine Corps Community Services, 2012).
While statistics show a decrease in suicide, there were Marines
attempting to take their own lives in 2012 than ever before. The Marine Corps reported there were 146
attempted suicides in 2008, 164 in 2009, and 172 in 2010, and 186 in
2011(Marine Corps Community Services, 2012). The Marine Corps is a smaller
branch and their suicide per 100,000 Marines outpaces the Army in most years
since 2002
The higher rates of suicide among the Army and Marines
have been linked to these branches being significantly more involved in combat
in Iraq and Afghanistan (Zoler, 2012). The DOD reports that there is an average
of 10 failed suicide attempts for each Soldier or Marine that takes their own
lives. It is estimated that more than
1,600 active duty Army and Marine’s attempted suicide in 2011 (Zoler).
United
States Air Force
The Air Force has fewer personnel in direct combat, but
Air Force suicides were at a 17-year high in 2010 (Svan, 2010). The Air Force reports that relationship
problems are the number one reason Airmen take their own lives. Chief Master Sergeant of the Air Force James
Roy reported that 100 Airmen committed suicide in 2011 and the total for 2012
may surpass this figure (Ricks, 2012).
The numbers of Airmen who have committed suicide in 2012 are a 40%
increase over the same time period in 2011. The Air Force has not released the
numbers for 2012, but some sources think that there were at least 18 suicides
in January alone (Ricks). If this figure
is repeated monthly the Air Force could reach 200 suicides in 2012, which could
put them ahead of the active duty Army.
Few Air Force officials believe that suicides will reach this number,
but it is clear that suicide in the Air Force is on the rise (Ricks).
United
States Navy
The
Navy started tracking suicides in 2001, and that year there were 40 suicides
(Navy Personnel Command, 2012). There
were 45 suicides in 2002, 44 in 2003, 40 in 3004, 37 in 2005, 38 in 2006, 40 in
2007, 39 in 2008, 46 in 2009, 39 in 2010, and jumped to 51 in 2011. Master Chief Petty Officer of the Navy Rick
West stated financial issues were a big factor in suicide within the Navy. 39% of Sailors that committed suicide in 2011
were facing disciplinary actions (Navy Personnel Command).
The
DOD reported that in 2009 service members with a history of Absent Without
Leave (AWOL) was found in 10% of suicides, 15% were facing military
disciplinary actions, 12% were facing civilian legal problems, and 27% had been
experiencing difficulties in their job (Navy Personnel Command, 2012). The
ability to find extrapolated statistics for suicides varied greatly for each
branch of the military. The Navy/Marine
Corps had the most detailed statistics available that outlined number of
suicides, attempted suicides, gender, race, age, marital status, pay grade, and
years in service. The Army and Air Force
statistics found only stated number of suicides and were vague on attempted
suicides.
Glantz
(2010) reported that suicide statistics for veterans may be understated. The VA identifies veteran suicides by
matching suicides that are recorded in the National Death Index with those
veterans that are enrolled in the VA.
There is no nationwide tracking system that identifies all veterans who
commit suicide. Due to this lack of data
the true numbers of veterans taking their own life is not known. There are only
6 million of the nation’s 22 million veterans enrolled in VA health services
(Glantz).
According
to Harrell and Berglass (2012), the reports that an average of 18 veterans
commit suicide every day is taken from the Centers for Disease Control’s
National Violent Death Reporting System, which only gets data from 18
states. By summer 2012, there should be
better data on suicide rates for veterans because of a partnership between
Veterans Affairs Secretary Eric Shinseki and 49 state governments. These states have committed to furnish the
statistics of veteran’s deaths within their states. It is reported that 950 veterans that were
enrolled in VA health care attempted suicide each month between 2008 and 2010
(Harrell and Berglass).
Stigma
against mental health problems in the military and limitations for veterans to
access confidential mental health care is one reason active duty and veterans
are not getting mental health treatment.
Half of those with significant symptoms and do access treatment are only
getting minimal care. (Tanelian & Jaycox, 2008). According to the American Psychoanalytic
Association (2009), the military, VA, and DOD have made attempts to remove the
stigma of seeking mental health care.
Stigma against mental illness is permeated throughout society and not
just within the military. Reducing
stigma has been a long-term effort, but service members speak out that stigma
is still alive and well within the military (American Psychoanalytic
Association).
Stigma
of mental illness prevents people from seeking help and this leads to a greater
risk of suicide. Suicide can seem like
the only option for a stigmatized person (American Psychoanalytic Association
(2009). In the military, stigma towards
mental illness is strong and many military service members deny any form of
mental health difficulty. This puts the
military population at greater risk of suicide.
A service member who admits to suicidal ideation is often perceived as
weak, shameful, sinful, and selfish and this keeps them from seeking help early
when treatment could possibly turn things around for the person (American
Psychoanalytic Association). The military states that they are reducing the
stigma of mental illness and that military leadership is leading the fight
against stigma. It is only recently all active duty Army bases conducted a
“stand-down” which stopped all normal duty day activities and required all
soldiers and leaders to attend classes and activities that addressed suicide.
According to Dreazen (2012), on January 18, 2012 Major General Dana Pittard
whom is the commanding general of the Fort Bliss Army post wrote on his
official blog:
"We lost a Fort Bliss Soldier
to an apparent self-inflicted gunshot wound. I heard the tragic news as I
walked out of a memorial service for another one of our Soldiers who decided to
kill himself at home on Christmas Day so that his family would find him.
Christmas will never be the same for his two young daughters he left behind. I
have now come to the conclusion that suicide is an absolutely selfish act.
Soldiers who commit suicide leave their families, their buddies and their units
to literally clean up their mess. There is nothing noble about suicide. I care
about each and every one of our Soldiers, family members and civilians at Fort
Bliss. I know there are a lot of people hurting out there, especially with the
future Army personnel cuts on the horizon. If you are hurting mentally or
emotionally, then seek and get help; but don’t resort to taking your own life.
I am personally fed up with Soldiers who are choosing to take their own lives
so that others can clean up their mess. Be an adult, act like an adult, and
deal with your real-life problems like the rest of us. SEEK HELP! If you need
help, please call 915-779-1800 or 800-273-TALK (8255). It is a confidential
call. Please look after each other; please do not allow your buddy to make a
rash decision that will have permanent life-ending consequences. Choose life.”
(Dreazen, 2012).
According
to Dreazen (2012), what General Pittard wrote on his blog is pervasive inside
the military and is just one example of how leaders feel about suicide. He retracted his statement after public
outrage within and outside of the military, but the damage was already
done. “Thanks to many of you and your
feedback, I have learned that this was a hurtful statement. I also realize that my statement was not in
line with the Army’s guidance regarding sensitivity to suicide. With my deepest
sincerity and respect towards those whom I have offended, I retract that
statement” (Dreazen, 2012). He wrote on
his blog what many in the military think about suicide and his words perpetuate
the already existing stigma inside the military (Dreazen). So many people in
the military that are in distress do not seek help for the very reason that
General Pittard wrote in his blog. This
stigma leaves with service members as they transition out of the military and
reintegrate back into the civilian community (Dreazen). Attitudes like
Pittard’s are pervasive in the military despite the push to reduce stigma,
Barbara Van Dahlen, the founder of Give an Hour, an organization that matches
troops with civilian mental-health providers stated:
"Soldiers
who are thinking about suicide can't do what the general says: They can't suck
it up, they can't let it go, they can't just move on. They're not acting out of selfishness;
they're acting because they believe they've become a burden to their loved ones
and can only relieve that burden by taking their own lives. His statement --
whatever motivated it can do little good for those who are already on the
edge." (Dreazen, 2012).
Barnett
(2012) stated destigmatisation should be addressed to mental illness as well as
suicide. General Peter Chiarelli, vice
chief of staff of the Army, the service’s leading fighter against suicide,
stated that the hardest part of reducing suicide is reducing the stigma. “I’m not going to kid myself. As hard as I try, and I brief every brigade
combat team going out, both in the National Guard and in the active component…I
see the head going up and down…In their mind, they really don’t believe these
injuries are as serious as the injuries that they can see” (Barnett, 2012).
Dr. Jonathan Shay (2002) stated that unit cohesion is an
essential tenant for military members in combat. He detailed isolation and despair in veterans
that he treated from the war in Vietnam because of the lack of unit cohesion. Unit cohesion is essential for trust and
trust is a main protective factor against suicide. Shay stated that soldiers run a risk of moral
injury from repeated combat tours. Shay
believes that a moral injury occurs when the concepts of trust and right and
wrong are lost during combat. A moral
injury can result from believing that they failed while under fire, or from the
failure of a commander that does not lead properly. When the soldier returns
home he is hyper vigilant and does not trust anyone. This leads to difficulty living life (Shay).
According to Shay (2002), the moral injury would be
lessened if soldiers were treated like a person instead of device with
interchangeable parts to one of looking at the soldier in a holistic
sense. Shay repeatedly states that money
is not the answer to the mental problems plaguing service members, but it is
the shallow of how trauma affects a person who serve in combat. Shay proposes
that what is missing is the buildup of trust, and insists that “competence is
an ethical imperative” (Shay, p. 223) and the military must demand a high
ethical standard for leadership and this will reduce the trauma in combat and
the horrors of returning home (Shay).
Currently there are two methods for conducting pre and
post deployment health assessments they are:
1. Telehealth- this is the main way they
do these screenings overseas -Most of the troops give the standard answer- I’m
fine. They know how to cheat on the exams given and they know what to say to
get out of that office fast. They deny anything wrong even when you see it
clear on their face and are pulled away before you can investigate further.
Since you are not on site you as the therapist are at the mercy of the
assistants. You can’t even give them your information and ask they return as
you are at a completely different site.
2. The 2nd method seen on CONUS
(Continental United States) bases consist of the providers breaking into teams
one team did a “briefing “the others did an “interview”. Buses- of troops are
brought over to a building. Each troop is handed a questionnaire to fill out-
they are given these by cadre in uniform, the Soldiers’ command is in the room
with them. They are allowed to talk- the scoring mechanism is on the sheet-
they are told- high scores go to see therapist, medium go to see therapist ,
low scores go to a mass briefing and can re-board the bus. (Here’s a Caveat, these soldiers are NOT from
this base (seen with many National Guard Units who do the screening at bases
outside their respective states) - if they do not pass redeployment assessment
they stay for treatment- you are just coming off a long deployment and are told
that if you have an issue it will be even longer before you get home.) The tests
are scored right there in front of the troop and they are broken into groups.
Some escorted to the next building – EVERYONE KNOWS the next building has the
counselors in it. The rest are taken into rooms and given a 5-10 minute brief
on PTSD and resources then dismissed. This brief is VERY short- if the
providers go to long they are reminded of time constraints. Now….remember that
bus- the troops are taken back to the bus. However, their fellow Soldiers who
were taken to the other building have to meet with a therapist- everyone is
waiting on the bus for those people to finish. EVERYONE now knows as the troop
walks back to the bus that he scored “moderate to high” for issues. The worse
you are often the longer it takes- each person meets with the therapists for
15-20 minutes unless they are so severe they require full escort to the
impatient ward.
The
problem with this method is: The troops share how to pass the exam- they
opening tell each other how to answer to avoid having to talk to someone- The
cadre does not stop this and the command encourages this. Even stating they
need to hurry up so we can get home. There is no privacy- if you have an issue
EVERYONE knows it the moment you are taken next door, or placed in “that”
group. They are hostage to their test-
admit issue and you are delayed in going home- answer that you are fine and you
are headed home.
While the military continues to address suicide with
“stand-downs” and numerous PowerPoint briefs to commanders at all levels the
biggest population that must be addressed is the lower enlisted ranks. When
Soldiers, Marines, Airmen and Sailors understand the complexity and the
severity of suicide and the wounds that many military and active duty members
face then will the acceptance of seeking help be successful.
