October 30, 2011

The Battle of Military Suicides

The Pentagon's efforts to acknowledge and address the problem of military suicides have been successful, by most accounts. Outreach, prevention programs, and increased mental-health services have likely saved lives. But when the most recent Defense Department data, based on the years between 2005 and 2010, show that service members take their lives at a rate of one every 36 hours, it is difficult to cheer. Meanwhile, the Veterans Administration now estimates that a veteran dies by suicide every 80 minutes.

The problem is systemic and growing. Tomorrow, the Center for a New American Security will issue the report “Losing the Battle: The Challenge of Military Suicide.’’ In a compelling narrative, the authors, Dr. Margaret Harrell and Nancy Berglass, provide workable recommendations to address this national crisis. But perhaps the study’s longest-lasting contribution is its explanation of why we, as a nation, should care at all.

There has always been the do-gooder answer - that this is what we owe to the men and women who have fought in Iraq and Afghanistan. But the suicide crisis is really about the future of our military. The shocking number of suicides in the all-volunteer force will make recruitment of the best talent vastly more difficult. Heartstrings aside, if service in an all-volunteer army comes to be associated with depression and misery, then solving the problem is as crucial for the next war as the ones now winding down.

This simple fact - that the fight against suicide is both about the individual and the institution - means the military can’t rest until its suicide rate is as low as that of the general population. And it must understand the different needs of those who have served and those who still wear the uniform.

For veterans, the biggest obstacle to a solution is that we have no systemic inventory of suicides in the veteran population. Most states do not indicate veteran status in their death data. So while the VA is estimating that 18 veterans kill themselves a day, that may not be capturing the full extent of the problem.

The fact that we do not know what’s behind many of these deaths is especially shocking, given the vast resources this nation spends on its veterans. If, for instance, veterans are killing themselves because of mental-health wounds dating from their time in service, then the services are not doing enough to protect them while in uniform. If they are killing themselves because of adjustment problems, addictions, or financial issues after their service, the solution might be in the VA and state support services.

For those still in uniform, some of the suicides may be by people who were already depressed or prone to depression at the time of their enlistment. But the fundamentals of military life may play a greater role than the fitness of the soldier, the report argues. Military families are expected to accept any and all changes “of station,’’ a military way of saying that these soldiers move a lot. By constantly changing bases and homes, the soldier’s access to health care is interrupted. Persistent mental-health issues are less likely to be identified by a shifting cast of health providers, and counseling and other support services are disrupted.

Even the informal support networks that can develop within a cohesive unit, especially one that has seen battle, can be altered when the group takes on new assignments, or some of its National Guard members return home. In response, the Marine Corps now prohibits units from disbanding for 90 days following return. Keeping the troops together may be the best way to keep some of them alive.

“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,’’ George Washington said. The military has always valued honor, leadership, and integrity. In return, it has promised that those who perform with courage will be valued by the institution. The suicide rate now threatens the perception that our soldiers could withstand ten years of war. Perhaps it was a demand we should never have made of them. But it’s in all our interest to fix it.

Juliette Kayyem can be reached at jkayyem@globe.com and Twitter @juliettekayyem