Army Report Examines Suicide Prevention Efforts

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A recently released Army report calls on Army leaders to take a “holistic and multidisciplinary approach” to address the risk of suicide among soldiers. The report, Army Health Promotion, Risk Reduction, Suicide Prevention Report 2010, provided results of a review of the Army’s suicide prevention efforts. The report identifies gaps in policies and procedures pertaining to identifying and preventing high-risk suicidal behavior in soldiers, as well as what should be done to correct these gaps.

In FY 2009 the Army had 160 active duty suicide deaths, with 239 across the total Army (including reserve component). Additionally, there were 146 active duty deaths related to high-risk behavior including 74 drug overdoses. Leadership is important in tackling the issue. “Now more than ever, our soldiers need firm, fair, and consistent leadership,” the report stated.

Enforcing Policies

The report called on leaders to do a better job of leading soldiers in garrison. While commanders and subordinate leaders are “phenomenal warriors,” they are “unaccustomed to taking care of soldiers in a garrison environment.”

There are instances when a leader’s lack of soldier accountability resulted in a suicide victim not being found for three or four weeks, the report stated. “In an organization that prides itself on never leaving a soldier behind, this sobering example speaks to the breakdown of leadership in garrison, which appears to be worsening as the requirements of prolonged conflict slowly erode the essential attributes that have defined the Army for generations.”

Leaders must make sure they are complying with referring soldiers with a drug positive urinalysis to the Army Substance Abuse Program (ASAP). The report cited that potentially 30-40% of soldiers who received a DUI citation or were positive for illicit drug use were never referred to the ASAP for a clinical evaluation. “Consequently, commanders are unsure of the readiness, fitness, health, and wellness of their soldiers. Drug and alcohol abuse can also be a sign of behavioral health problems.”

The report also cited the need for leaders to comply with filling out DA Forms 4833, the Commander’s Report of Disciplinary or Administrative Action, when necessary. Currently, the compliance rate for filling these forms out is about 64%. “Unfortunately, without DA Forms 4833 to provide this record, many incidents are viewed in isolation. Consequently, a repeat offender can be misconstrued as a one-time offender and every trend dismissed as an isolated incident,” according to the report.

The report also pointed to the importance of screening for behavioral health issues in the primary care setting. While soldiers may be resistant to seeking behavioral healthcare, they are required to be assessed annually by a primary care physician as part of their periodic health assessment. “In fact, it is reported that approximately 90% of soldiers in a given year have at least one primary care visit. This encounter creates an opportunity for identification of physical symptoms associated with behavioral health conditions.”

The report also recommended limiting prescription duration to one year after a prescription is issued in order to ensure that legitimate prescription use does not turn into prescription abuse. Under this recommendation, a prescription would not be considered valid after one year without the provider renewing it.

The report includes over 250 recommendations to correct gaps in the system. “It not only says where we are today and what we’ve done so far to try to fix it, but it also lays out a way ahead for how we’re going to get us back to where we need to be. And that is absolutely critical,” Gen Peter Chiarelli, vice chief of staff of the Army, who headed the task force that put together the report, said at a briefing at the end of July.

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  1. AWT says:

    Can you please tell me what specific studies have been conducted on the Periodic Health Assessment’s validity, specifically as a screener for depression and suicide?

    More questions – who designed the screener; what studies evaluate its effectiveness; whether there are any data on the number of false negatives/missed positives when Soldiers respond no to the first two depression questions (so that the next questions are not asked); to what extent do replies to each question predict risk; and how many providers ask about suicide when a Soldier has answered no to the first two questions.

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