PTSD Infographic

Source: OnlineMilitaryEducation.org

[Source Blackwater Law]

“Is a leader made or Born?”

 

“Is a leader made or Born?”

This is a question that has been included into the syllabi of every leadership school I have attended from Primary Leadership Development Course to the Senior Leader Course. There is no definitive answer to whether a person is born a leader or made a leader. Instead it seems that leadership is a combination of intelligence and aptitude.  For this post I will discuss the history of the study of leadership and also how the Biological approach and the humanistic approach would explain the personality traits that are associated with the subject of leadership.

            To understand leadership and the development or nurturing of it I thought it was important to look at the way leadership has been studied over the years. Two early foundations of the leadership concept are; philosophy and moral law.

            Leadership has numerous theoretical roots. Socrates in Plato’s Republic, said that the “leadership of civil institutions were to be reserved for the “specially” trained philosopher-kings, not to the ill-trained or uniformed masses who were meant to be followers.” (Hays, 1967)  Many military classes at West Point or The Naval Academy still quote Sun Tzu when discussing senior and subordinate relationships. Aristotle described moral conduct and behaviors that all leaders should poses, these “codes” influenced many great leaders notably Alexander the Great. Machiavelli describes the cruelty, dishonesty, and sometimes brutality that were shown by leaders in his book The Prince.

            Moral Codes affect many concepts of leadership. Marcus Aurelius spoke often of the moral and ethical responsibilities leaders were held too under the Roman Empire. Judeo-Christian teachings emphasize the divine source from which all leadership is derived from.      These teaching have emphasized the necessity for the up most ethical standards by all leaders.  Moral Codes were the foundations for the formation of the Japanese code of conduct known commonly as Bushido or the “The Warriors Way” which emphasized tenets such as honor, loyalty, and frugality. The west had a much similar concept known as chivalry which also emphasized the duty to your king, to your God, and to your women. In today’s Army Officers and Non-Commissioned officers are consistently judged on their moral and ethical standards.

 

             The psychological and trait approach to leadership can raise numerous questions about the development and the emergence of the leadership trait or quality. Using the biological approach or more specifically Hans Eysenck’s theory on personality a leader exhibits some of his personality dimensions on certain levels. The first being extroversion, a leader can usually be described as an A-Type personality. The leader is usually outspoken and can excel within the group dynamic, the leader is usually an outgoing person that has many contacts. Most leaders are usually not introverted, but in my experience I have seen some of the more effective leaders that were border line introverted. Much of their leadership was derived from charisma and their knowledge of their profession, this in turn prompted respect from their subordinates. Neuroticism is a trait that a leader does not want exhibit because having very strong emotional reactions to minor frustrations may not solve the problem but may in fact exacerbate the problem, especially with subordinates, because a leader needs to be a level headed person that weight facts objectively without investing to much emotional bias into the problem. But then again a leader does not want to display the psychoticism supertrait because he does not want to appear cold or impersonal to the subordinate. A good leader needs to be empathetic and show concern for them.

            The humanistic approach to leadership would say that the leader is in a position that he chooses to be in and that nobody is forcing him to take the responsibility that he has chosen to take. The humanistic approach would say that a leader takes personal responsibility for the actions he or she chooses to take or not take and in effect suffer the consequences of their action or bask in the glory that may come from the decision to act. From the humanistic perspective a psychologist may say that a leader is ineffective because they spend too much time planning on the future or reflecting on the past. The humanistic psychologist may also say that a leader should remember their past experiences but should not allow them to dictate what they are. We all know that much of leadership is derived from the experiences that they gain throughout their career.

            Leaders can be classified into different categories. The first category is the manner in which the leader achieves his or her position. In informal groups a leader may emerge from the group by asserting himself or herself.  This can be an example of the “born” theory, in which the individual is able to shut down his competition and take over. In the Army we often call this “initiative” and it is part of the Army’s definition of leadership which is; “the ability to influence others to accomplish the mission by providing purpose, direction, and motivation.” The charismatic leader is much like the emergent leader. The charismatic leader is that person that can walk into a room and all eyes turn to look and people seem to just gravitate towards.  The charismatic leader may not have the technical or the tactical experience that some other leaders may have but they still have the ability to influence people to follow them an example of this type of leader is Adolph Hitler.

            The second category is the more formal raise in the hierarchy of leadership.  The rise to a leadership position may either through a democratic process, such as our elected officials.  These leaders were “made” in the sense that they went through the education process and climbed through the ranks to get to that position. In the Army I came in as a private and served first as a rifleman, then progressed to the position of team leader, squad leader, platoon sergeant, and first sergeant.  In my experience it is important for a leader to progress through the ranks and serve in those positions where “the rubber meets the road”.  Each position capitalizes on the experience of the previous position. 

            An example of great leadership can be found in the movie We were Soldiers. In this movie Mel Gibson plays Lieutenant Colonel (LTC) Hal Moore the Commander of the 1^st Battalion, 7^th Cavalry. General Moore graduated from West Point in 1945 and attended graduate school at George Washington and Harvard University. Later in his career he taught at West Point where General Norman Schwarzkopf was one of his students.  General Schwarzkopf would later comment that General Moore was the biggest influence in his decision to become an Infantry officer. The 7^th Cavalry was the unit General George Armstrong Custer led in the Battle of the little big horn.  Prior to their deployment to Vietnam LTC Moore gives a speech to his Soldiers saying;  "Look around you, in the 7th Cavalry, we got a Captain from the Ukraine, another from Puerto Rico, we got Japanese, Chinese, Blacks, Hispanics, Cherokee Indian, Jews and Gentiles, all American. Now here in the States some men in this unit may experience discrimination because of race or creed, but for you and me now, all that is gone. We're moving into the valley of the shadow of death, where you will watch the back of the man next to you, as he will watch yours, and you won't care what color he is or by what name he calls God. Let us understand the situation; we're going into battle against a tough and determined enemy. I can't promise you that I will bring you all home alive, but this I swear: when we go into battle, I will be the first one to set foot on the field, and I will be the last to step off. And I will leave no one behind. Dead or alive, we will all come home together. So help me God."

LTC Moore was able to draw from his experiences leading Soldiers and from his education which taught him the principles of leadership. These experiences would later be passed on to his students at West Point. All leaders draw upon their experiences as a foundation for developing their own style of leadership. So is a leader made or born? With the proper education I believe that anybody has the potential to be a leader but at different levels of responsibility. Leadership is a lifelong process and when you think you have seen it all you get blindsided by some new situation or a subordinate that you just can’t seem to figure out.

Work Cited

Adams, N. M. (1992). The Prince. New York: W.W. Norton & Company.

Hays, C. S. (1967). Taking Command. Harrisburg: STACKPOLE BOOKS.

Veterans diagnosed with PTSD are more likely to die from suicide than those without PTSD

Hello everyone I apologize for not being as pro-active in keeping up my blog. Well a lot has happened since my last post. I am now in my final two semesters of graduate school (graduate Aug 2014) I also have run into a few bumps in the road that have helped re-evaluate some actions and think about how poor choices can adversely effect the goals you place for yourself. But more about that later! As for now I want to post a few things I have written concerning suicide and the impact that Post Traumatic Stress Disorders plays in increasing the propensity for completed suicide as well as increased attempts. Although this is a dark subject it is something that needs to be addressed.

 

Suicide is unquestionably the most challenging mental health issue after Post Traumatic Stress Disorder (PTSD) that is being faced by the military today. Suicide has been the second leading cause of death in the United States military, exceeding the number of combat-related losses in both Iraq and Afghanistan (Rudd, 2012).

Veterans diagnosed with PTSD are more likely to die from suicide than those without PTSD, and this risk is substantially greater among veterans with PTSD and comorbid mental disorders such as substance abuse (Jakupcak, 2011).

Can addressing PTSD decrease the number of suicides by service members diagnosed with PTSD? Yes, and steps are currently being taken to further research and present empirical and best treatment practices that will lessen the symptoms of PTSD and thus reduce the number of suicide attempts and completions. While there are a number of treatment options available to practitioners the three that have been successful are: Cognitive Behavioral Therapy more specific Cognitive Therapy, Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) Therapy (see figure 1). For the purpose of this paper I will discuss Cognitive Behavioral Therapy in which the treatment focus relies on relearning thoughts and beliefs generated from the traumatic event, which may impede current coping skills.

Studies have linked the relationship between suicidal ideation and self-reported psychiatric symptoms among 407 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) combat veterans in a post deployment study at a specialty Veterans Affairs clinic. Accounting for symptoms of major depressive disorder, alcohol abuse, and illegal drug abuse, veterans who screened positive for PTSD were found to be more than four times more likely to report suicidal ideation relative to non-PTSD veterans (Jakupcak, 2011).

 Cognitive Behavioral Therapy is an individualized type of psychotherapy used to treat PTSD that is based on the principles of learning theory and cognitive psychology. From a cognitive psychological perspective, trauma exposure is thought to evoke erroneous automatic thoughts about the environment (as dangerous and threatening) and about oneself (as hopeless and incompetent). CBT directly confronts such PTSD-related distortion thinking.

 Cognitive therapy addresses the thoughts and beliefs that are often associated and generated by the traumatic event rather than the conditioned emotional responses addressed by exposure therapy. This approach focuses on how individuals with PTSD have interpreted the traumatic event with respect to their appraisals about the world and themselves (Friedman, 2003).

 Cognitive therapy has a number of elements that are distinctive in its treatment plan compared to others types of therapy. Some of the elements that make it appealing to service members and their families include being relatively short-term (for the most part), active, directive, structured, and collaborative, with a core theme being the development of individual understanding, coping, and mastery of skills essential for day-to-day living (Rudd, 2012).

There have been several studies that have shown that the effectiveness of CBT in reducing suicidal behaviors. There are several effective treatments used to reduce suicidal behaviors and they all share several of the same common elements, including theory-driven, structured strategies that are designed to target suicidal risk factors, increase motivation and treatment compliance, and introduce skills training to promote self-reliance, responsibility, and the ability to manage distress and crisis. A 2005 study by Brown, G.K titled Cognitive therapy for the prevention of suicide attempts: A randomized controlled trial found that, compared to participants receiving usual care from community providers, participants in CBT therapy for suicidality reported significantly less depression and hopelessness six months after initiating therapy and were significantly less likely to reattempt suicide in the 18 months following their initial suicide attempt (Jakupcak, 2011).

One proposed approach to treating PTSD with OEF/OIF veterans at high risk for suicide is based on a treatment plan with core features of psychosocial interventions designed for the treatment of suicidal behaviors and the treatment guidelines proposed by the International Society for Traumatic Stress. This successful (validated and reliable) approach consists of three phases: (a) comprehensive assessment, treatment engagement, and initial safety planning; (b) suicide risk reduction and CBT skills specific to suicidality; and (c) CBT for PTSD and comorbid mental disorders. The implementations of the three phases are only the beginning of a whole treatment concept which involves maintaining regular supportive contact, fostering motivation for treatment, and continually assessing changes in risk factors and symptoms must remain a priority through the treatment process.

Phase I: Assessment, Treatment Engagement, and Initial Safety Planning

  This phase allows the clinician and initial assessment opportunity to fully assess warning signs and risk factors involved in suicidal behaviors. This time can be critical in establishing rapport necessary to engage the veteran in care. Not only is this a time to discuss things such as unanticipated assignments outside of the veterans primary Military Occupational Specialty (MOS) but also the possibility of being personally re-deployed or the possibility of friends or family members being redeployed it is also a time to assess other factors of risk behaviors such as recent aggression, smoking status, family history of suicide, childhood or adult sexual or physical victimization, and current access to firearms. This will assist the provider in estimating the level of current risk and will help to guide safety and treatment planning (Jakupcak, 2011).

Phase II: Suicide Risk Reduction and CBT Strategies Targeting Suicidality
 After the initial assessment takes place suicide risk reduction and safety plan refinement is an ongoing process. The clinician is encouraged to take the lead in facilitating a coordinated treatment plan, with each provider identifying their role in a collaborative process to reduce suicide risk. There are many ways other treatment providers can provide critical support in the reduction of suicidal risk. During this phase the veteran is encouraged to identify specific emotional states that frequently cue suicidal thoughts (Jakupcak, 2011). Those veterans that devalue or fear discussing vulnerable emotions may benefit from an emotional examination of personal and cultural schemas regarding traditional norms as part of the emotional skills training. Reviewing both general and idiosyncratic functions of specific emotional states can normalize the experience of vulnerable emotions and help to address skills deficits (Jakupcak, 2011).

Phase III: Treating PTSD and Comorbid Psychiatric Symptoms

After the introduction of the safety plan and basic CBT skills to help reduce suicidal thoughts , impulses, or self-harm behaviors, it is important to address more specific psychiatric disorders. During this phase it is important that the provider remain flexible approach in treating specific disorders and other psychiatric symptoms, carefully monitoring safety, continued ambivalence, and resistance to treatment. It is not uncommon that for the veteran to become resistant to the treatment process. These resistance actions can be seen through active resistance (e.g. cancelling appointments or no-showing multiple appointments, using alcohol, or other substances immediately prior to or following a session) or may be expressed less directly through such behaviors as forgetting to do “homework for sessions, or bringing up topics that distract from trauma-related session (Jakupcak, 2011). See figure 2 for some common barriers to mental health care in general population and among former deployed military personnel.

 The most common resistant that most veteran’s exhibit is substance abuse, substance use can increase impulsivity and suicidality, but OEF/OIF veterans abusing alcohol may not be aware of the problematic nature that their drinking may be playing in their recovery process. Many veterans will reference their behaviors to peer-based norms and may even perceive benefits from alcohol consumption in terms of sleep and anxiety reduction (Jakupcak, 2011).

  In conclusion the necessity to understand local and national resources that are available to practitioners who work with OEF/OIF veterans are important to help with complex psychiatric profiles and physical disorders. IT is also important to acknowledge that treating patients who are at risk for suicide is often both challenging and stressful to providers. A substantial portion of mental health providers report having experiencing a patient suicide (rates that vary 11% to 50% across types of professions and clinical settings) and providers may experience significant emotional distress in response to a patient’s suicide attempt or completed suicide. It is just as important for providers to seek out appropriate supervision, consultation, and peer support.

  
Figure 1:

Cognitive Behavioral Techniques Used in PTSD Treatment
CBT Technique	Treatment Focus
Prolonged Exposure Therapy (PE)	Disconnecting the overwhelming sense of fear from trauma
Cognitive Therapy	Relearning thoughts and beliefs generated from the traumatic event, which impede current coping skills.
Cognitive Processing Therapy (CPT)	Understanding both emotional and cognitive consequences of trauma exposure
Stress Inoculation Training (SIT)	Anxiety Management to increase coping skills for current situations.
Interapy	Exposure and cognitive restructuring through a protocol-driven CBT treatment accessed via the internet.
Imagery Rehearsal Therapy	Changing disturbing traumatic nightmares by rehearsing "new dreams"
Biofeedback and Relaxation Training	Anxiety management to help patients master overwhelming anxiety feelings and physiological reactions elicited by a trauma reminder.
Dialectical Behavior Therapy (DBT)	Treating borderline personality disorder, a syndrome of associated with PTSD and complex PTSD.

 Figure 2:

Barriers To Mental Health Care in General Population and Among Former Deployed Military Personnel
In General Population  (Kessler, Berglund, et al., 2001)	Among Formerly Deployed Military Personnel (Schell and Marshall, 2008)
Lack of perceived need	Negative career repercussions
Unsure about where to go for help	Inability to receive a security clearance
Cost (too expensive)	Concerns about confidentiality
Perceived lack of effectiveness	Concerns about side effects of medications
Reliance on self (desire to solve problems on one's own or thoughts that the problem will get better)	Preferred reliance on family and friends
	Perceived lack of effectiveness

 Written by Gene Hicks 2013

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A year in review 2012.

With the end of 2012 quickly upon me I wanted to take a few moments to reflect on all that has transpired in the last 12 months that have impacted my life and the lives of those around me. Also, to show all of you who read this that good things do happen and that patience is truely a virtue that is undersold.

School
I was accepted and completed my first two semester of graduate school . While this is an accomplishment in itself it is a big stress especially for us with TBI's and PTSD. I would find myself becoming very agitated at myself for not understanding material I thought was simple. I would seclude myself and then get over anxious about a paper or required reading. I am now working with a Speech Pathologist as well as an Occupational Therapist who will teach me not how to study but how to learn with and use my disabilities to my advantage. I will keep you all posted on the skills that I learn so that maybe you can benefit from them too.

Disability Rating
I was notified that I had received a disability rating of 70% for PTSD. This stunned me, scared me and really kind of put me in the dumps. I understood what PTSD is but to actually have someone tell you that you have it and that it impacts your life so substantially it requires medical help is a hard pill to swallow. But I took this as a sign that I as a counselor have the unique ability to empathize with my veteran clients because I too have seen the horrors that are associated with war. I continue to learn coping methods and my own symptomology just so that I am self aware. I was accepted into the Vocational Rehabilitation services with the VA and am excited to have them help with school.

New family and new beginnings
My daughter and her four children (ages 8,6,3,2) left Arizona and moved into my modest 3 bedroom home. I have not had small children in the house for years and the noise that is associated with them was quickly remembered. While it is a big change that I my Fiance' and her 11 year old son have had to take head on its been a experience I would never change. It is good to have family that will help out no matter what the cost and equally great to be able to be this involved with my grandchildren as they grow up.

Old friends and new friends
I am amazed that I have the friends that I have. Each and everyone of them are a treasure that I hold tight. My best friend Jerry and his wife Nancy have kept me sane through many trials this year and I am honored to call them friends. As I move towards my 20th month of retirement (not that I am counting) I can't help but feel like it seemed so long ago that I was wearing ACU's and holding morning formations.

I hope you all have a wonderful New Years celebration and hold tight the memories of your year. My friend and I were talking yesterday about what a great journey our lives have been and that we should never take that for granted because we have comrades, friends and Soldiers whose journey was cut short. RIP John Hallett, Tom Troy, Bill Jacobson, Clint Gertson, Graham, Dennis Williams and all my boys I will see you on the high ground

Death Dealer 7, Out

Suicide in the military - One is too many

 

 

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.