November 07, 2011

Brief: DoD Must Alter Suicide Prevention Plan

Military suicides threaten the health of the all-volunteer forces and the Pentagon is “losing the battle” to prevent them, with active-duty members taking their own lives at a rate of one every 36 hours, a new report concludes.

The policy brief, “Losing the Battle: The Challenge of Military Suicide,” from the Washington-based Center for a New American Security think-tank, exhorts the Defense Department to change protocols and policies that it says hinder suicide-prevention efforts.

It recommends changes ranging from establishing unit cohesion programs after deployments to encouraging commanders to speak with troops about their privately owned firearms.

Service in wartime, say authors Margaret Harrell and Nancy Berglass, can chip away at three endemic human factors that keep people from committing suicide. Some psychiatrists have identified these as belongingness, usefulness and a natural aversion to pain or death.

According to the report, service members feel a strong sense of belonging when they are in a field unit, but this may wane after they transfer from their unit or leave the military.

Troops also may feel less useful after they return to a garrison environment, a civilian job or unemployment.

Finally, repeated exposure to military training and operations erodes one’s sense of self-preservation and increases pain tolerance.

A loss of any of these factors “may predispose an individual to suicide,” the report states.

It made a total of nine recommendations based on these suppositions and a review of available research. Among them, leadership must:

• Ensure that information about troops’ mental well-being moves with them to their next duty station.

• Encourage troops to respond truthfully on post-deployment mental health screenings.

• Reiterate that hazing is prohibited in the services in light of research that shows 1 percent to 2 percent of military suicides are related to hazing.

• Continue efforts to remove the stigma of seeking mental health treatment.

• Urge behavioral health-care providers to tell unit commanders if they consider a service member to be at high risk for suicide.

That last recommendation, the authors admitted, is controversial because privacy regulations protect patients’ rights. But it is essential, they said. “Leaders are best able to help their troops when they know individuals are struggling,” the report states.

Additional recommendations lie outside the Defense Department’s purview. For example, CNAS recommended that Congress increase the number of mental health professionals at the Defense and Veterans Affairs departments, and overturn a provision in the 2011 Defense Authorization Act that bars military leaders from collecting information related to a service members’ ownership or possession of a legally acquired firearm.

“I am not allowed to ask a soldier who lives off-post whether that soldier has a privately owned weapon,” said Army Vice Chief of Staff Gen. Peter Chiarelli at a CNAS-sponsored event held in Washington.

“If you have someone who is high-risk, the studies I’ve read indicate you should separate the individual from the weapon. If you could do that, you could lower the incidence. But we have issues in being able to do that,” he said.

Referring to suicides as the biggest challenge of his 40-year military career, Chiarelli took issue with some of the report’s findings — and its title.

“The implication that we’ve done little … could not be further from the truth,” he said. “I do not believe we are losing the battle. … I believe we’ve made tremendous progress in understanding this complex issue.”

Chiarelli said no suicides are acceptable, but added that doing more to help the large number of troops with behavioral health issues will reduce the suicide numbers. “This is a national problem. We just don’t have enough behavioral health care specialists,” he said.

Chiarelli said it’s impossible to gauge the success of any suicide prevention programs because “the Army doesn’t know how many have contemplated suicide and as a result of our collective efforts did not end up doing it,” he said. He argued for more brain research and said nationwide, the stigma of mental health treatment needs to disappear.

“The hard part is eliminating the long-standing stigma, breaking down the invisible barrier that is as prevalent in society as it is in the military,” he said.

VA also is struggling with the question of suicide. VA estimates that 18 veterans commit suicide daily, but Dr. Jan Kemp, VA’s national mental health program director for suicide prevention, calls that a “best guess” because only 17 states report veteran suicides to a nationwide Centers for Disease Control database.

VA is building its own tracking system and 48 states have agreed to take part. Colorado and Illinois are the holdouts, Kemp said.

To combat the rising number of veteran suicides, VA has launched a number of programs, including a Veterans Crisis Line, which has received 450,000 calls since it opened in July 2007.

Kemp acknowledged more must be done. “As long as any veteran or service member dies by suicide, we are in fact losing the battle, but we I maintain we are making huge strides in winning the war,” she said.