WASHINGTON, DC—The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and VA held a conference last month examining suicide and suicide prevention. “For all of our sophisticated knowledge, we still do not know all there is to know about preventing a needless death from occurring,” Ellen Embrey, the acting Assistant Secretary of Defense for Health Affairs, told more than 1,000 military and other government personnel who gathered at the conference.
Embrey said that 311 suicides occurred in the military in 2009 and further noted that a 2008 DoD report found that 64 percent of those who died by suicide did not have a diagnosed psychiatric disorder. Further, a full 49 percent had received medical, behavioral, and family services 30 days before their deaths. “Knowing this, what is it that we can do to reduce the risks and the number of suicides in the Armed Forces?” she asked.
VA Secretary Eric Shinseki, who also addressed the conference, called the suicide problem one of the “most frustrating” leadership challenges he faces. On average, 18 veterans commit suicide each day. “Five of those veterans are under the care of the VA. Losing five veterans who are in treatment every month, and then not having a shot at the other 13 who for some reason haven’t come under our care, means that we have a lot of work to do,” he said.
At VA, he said, there is a need to raise awareness of suicide indicators and the array of work, economic, and social factors that can trigger them—not just in patients, but in the workforce as well. “How do we foster and sustain the goodness of the buddy system that’s inherent culturally in nearly everything that the military does and apply it in VA amongst a population of 7.5 million that is diffused, expansive, highly individualized, and spans ages 18 to 80 plus? I believe it can be done for specific Veteran subgroups…for instance, those pockets of new Veterans now clustering at colleges and universities across the country,” he said.
Shinseki also said that the old way of approaching mental health counseling and suicide prevention will not work as effectively for “youngsters of the new millennium.” He noted that they have never known a world without cell phones, the Internet, and instant messaging. “Engaging them requires a new and different model that is not necessarily across a desk in an imposing government building, but in coffee shops down the street, on their cell phones, on the Internet, or through a public service announcement they see on their flat screen TV or read about in a blog,” he said.
The VA, Shinseki said, has expanded its mental health workforce, hiring more than 4,000 new employees in the past three years alone, for a total of 19,000 mental health staff members.
Reducing Suicides in the Army
Army Col Elspeth Ritchie, a psychiatrist in the Office of the Army Surgeon General, called the Army suicide rate “unacceptable.” According to the Army, there were 160 reported active duty Army suicides during 2009. Of these, 114 had been confirmed as of mid January, and 46 were pending determination of manner of death. During 2008, there were 140 suicides among active duty soldiers.
In the Army, statistics have shown that one-third of those who commit suicide have never deployed, about one-third occur in theater, and another one-third happen post-deployment. About 50 percent of soldiers who commit suicide have been seen by a mental health professional in the year before their death.
One of the challenges in dealing with suicide is figuring out how to do a good suicide risk assessment. The Post Deployment Health Assessment that assesses a servicemember 30 days after deployment and the Post Deployment Health Re-Assessment that is completed by the soldier 3 to 6 months after returning from deployment are not designed as suicide screens, according to Ritchie.
Ritchie also pointed to the easy accessibility of guns as an issue in grappling with the suicide problem. “It perturbs me when you walk into the [Post Exchange] at Fort Campbell, which is at the top of the list with a high suicide rate, andthey have a beautiful gun shop in the middle,” Ritchie said.
Another area that the military is looking at is presidential condolence letters. Currently, the families of servicemembers who commit suicide do not receive the standard presidential condolence letters that families receive who have servicemembers who die in a war zone. “One of the things that families have complained quite a bit about is that they don’t get the same honor as those who have been killed in battle. They don’t get the letter from President Obama, and that is one of the things that the casualty affairs office is working on,” she said.
The Army has been sending mental health assessment teams into Iraq and Afghanistan over the course of the conflicts to gather mental health data and that has shed light on mental health issues. In November, the results from the sixth assessment were released. That study found that soldiers in Afghanistan are experiencing a high rate of combat exposure and that the difficult terrain often made it challenging to connect soldiers with care.
The study called for an increase in mental health providers in Afghanistan. According to Ritchie, “Afghanistan is tough for the delivery of care…The difficulties of terrain and weather makes it very challenging to get care to soldiers.”