November 08, 2011

Improve Mental-Health Care for Our Troops

"The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the Veterans of earlier wars were treated and appreciated by their nation." That quote from George Washington concludes a new study by the Center for a New American Security (CNAS) on the links between suicide and service in the U.S. Armed Forces.

There is no question that veterans are treated better now than they were following the Vietnam War, but the CNAS study reveals that veterans and service members are committing suicide at alarming numbers -- one every 36 hours for service members, one every 80 minutes for veterans.

The study provides many recommendations, among them the need to maintain unit cohesion for 90 days following a return from deployment, a policy that has been used by the Marines for some time but not by the Army. This is a critical policy recommendation because it is precisely during times of non-deployment, when soldiers are living on a base away from combat, or are seeking a job in civilian life, that they are most at risk of suicide.

Why? Because during periods of non-deployment, soldiers, who have developed a camaraderie within the ranks and who typically feel a strong sense of purpose while in combat, can lose that sense of what the study's authors term "belongingness and usefulness." Those are two of the "protective" factors that have historically insulated soldiers from suicide. But when troops return to a garrison environment or to civilian life, where the roughly 12 percent unemployment rate for soldiers remains higher than that for the general population, they, in particular Guardsmen, Reservists and veterans, are at a higher risk of suicide than before.

The report recommends de-stigmatizing mental illness within the military by having commanders encourage troops when they come home to fill out a post-deployment health assessment (PDHA) honestly. An anonymous survey of service members, conducted in 2008, revealed that "rates of depression, PTSD, suicidal thoughts and interest in receiving care were two to four times higher as compared to the PDHA."

The Department of Defense has made strides in requiring that the PDHAs be conducted face to face and by trained medical or behavioral health professionals, two conditions that were often absent in the past. Those requirements, mandated by the 2010 National Defense Authorization Act, have spurred more troops to come forward when they are depressed or suicidal.

The CNAS report indicates that more and more service members are seeking help than before; 57 percent of military suicides sought help in 2010 compared to 36 percent in 2009. Sadly, that still leaves 43 percent who did not seek help, a failing that is no doubt due to the stigma of admitting to being mentally ill.

As I have written before, only one person can truly change the way our troops and veterans view mental illness, and that is President Obama, our commander-in-chief.

Obama should use the bully pulpit to urge troops and veterans to seek help if they are depressed, suffering from PTSD or suicidal. He should also trumpet legislation to fund more mental-health counselors for the armed forces and for veterans. Finally, he needs to overhaul the policy on condolence letters.

Following Memorial Day this year, I wrote a piece calling on Obama to write such letters to the families of all troops who commit suicide. A month later, the president did change the policy, but only partly. Rather than writing letters to all the families of military suicides, he decided to write such letters only when the suicide occurred in combat.

I praised Obama for improving the policy but criticized him for not changing it all the way. As I wrote in July, the vast majority of military suicides occur outside of a battlefield, so the policy is not only inadequate, it is "asinine" and "demeaning" to the families whose loved ones took their lives outside of combat.

Why should we value the life of a suicidal service member more if he took his life in combat in Iraq or Afghanistan than if he took his life back in the United States after serving in one of those theaters?

The answer is that we should not. All of those lives should be valued and memorialized.

With Veterans Day approaching, I urge President Obama to consider changing the policy once more. By writing condolence letters to the families of all troops who commit suicide, he will help to end the stigma against mental illness in the U.S. Armed Forces and in this country.