DOD, Services Work to Prevent Suicides

WASHINGTON — Offi­cials know the facts about sui­cide in the mil­i­tary ser­vices, but the caus­es and best means of pre­ven­tion are more elu­sive, a senior Defense Depart­ment offi­cial said today.

In tes­ti­mo­ny before the House Armed Ser­vices com­mit­tee, Dr. Jonathan Wood­son, the assis­tant sec­re­tary of defense for health affairs and direc­tor of the TRICARE Man­age­ment Activ­i­ty, said DOD has invest­ed “tremen­dous resources” to bet­ter under­stand how to iden­ti­fy those at risk of sui­cide, treat at-risk peo­ple, and pre­vent sui­cide.

“We con­tin­ue to seek the best minds from both with­in our ranks, from acad­e­mia, oth­er fed­er­al health part­ners, and the pri­vate sec­tor to fur­ther our under­stand­ing of this com­plex set of issues,” Wood­son said.

The over­all rate of sui­cide among ser­vice mem­bers has risen steadi­ly for a decade, he said, and DOD and the ser­vices are tak­ing a mul­ti­dis­ci­pli­nary approach in their efforts to save lives.

The Defense and Vet­er­ans Affairs Depart­ments are devel­op­ing shared clin­i­cal prac­tice guide­lines that health care providers in both agen­cies will use to assess sui­cide risk and help pre­vent sui­cide attempts, Wood­son said.

DOD also is work­ing with the Depart­ment of Health and Human Ser­vices and the Sub­stance Abuse and Men­tal Health Ser­vices Admin­is­tra­tion to offer crit­i­cal men­tal health ser­vices to Nation­al Guard and Reserve mem­bers, who often don’t live close to mil­i­tary med­ical facil­i­ties, he added.

Wood­son acknowl­edged much work remains.

“We have iden­ti­fied risk fac­tors for sui­cide, and fac­tors that appear to pro­tect an indi­vid­ual from sui­cide,” he said. “As you well under­stand, the inter­play of these fac­tors is very com­plex. Our efforts are focused on address­ing solu­tions in a com­pre­hen­sive and holis­tic man­ner.”

Defense sui­cide pre­ven­tion research includes Army ‘STARS,’ a study to assess risk and resilience in ser­vice mem­bers, Wood­son said.

“This is the largest sin­gle epi­demi­o­log­ic research effort ever under­tak­en by the Army, and is designed to exam­ine men­tal health, psy­cho­log­i­cal resilience, sui­cide risk, sui­cide-relat­ed behav­iors and sui­cide deaths,” the assis­tant sec­re­tary said.

The study, he said, involves experts from the Uni­form Ser­vices Uni­ver­si­ty of the Health Sci­ences, Uni­ver­si­ty of Cal­i­for­nia, Uni­ver­si­ty of Michi­gan, Har­vard Uni­ver­si­ty, and the Nation­al Insti­tute of Men­tal Health.

STARS is exam­in­ing past data on about 90,000 active-duty sol­diers, eval­u­at­ing sol­diers’ char­ac­ter­is­tics and expe­ri­ences as they relate to sub­se­quent psy­cho­log­i­cal health issues, sui­ci­dal behav­ior and oth­er rel­e­vant out­comes, he said.

DOD has added more than 200 men­tal health pro­fes­sion­als from the Pub­lic Health Ser­vice to med­ical facil­i­ties’ staffs, and is expand­ing access to ser­vices in civil­ian com­mu­ni­ties, Wood­son said.

“With­in the depart­ment, we have amend­ed med­ical doc­trine and embed­ded our men­tal health pro­fes­sion­als far for­ward … to pro­vide care in the­aters of oper­a­tion,” he added.

The depart­ment also has worked to col­lect, ana­lyze and share data more effec­tive­ly “so that the entire care team under­stands the diag­no­sis and treat­ment plan,” he said.

“As impor­tant as any step, we have also made great attempts to remove stig­ma from seek­ing men­tal health ser­vices, a stig­ma that is com­mon through­out soci­ety, and not just in the mil­i­tary,” Wood­son con­tin­ued. “This is a long-term effort, but both senior offi­cers and enlist­ed lead­ers are speak­ing out with a com­mon mes­sage.”

Defense lead­ers are encour­aged that ser­vice mem­bers increas­ing­ly now seek pro­fes­sion­al help when it is rec­om­mend­ed, he said.

The ser­vice chiefs of staff for per­son­nel also tes­ti­fied at today’s hear­ing:
Army Maj. Gen. Thomas Bostick, Navy Rear Adm. Antho­ny Kur­ta, Marine Corps Lt. Gen. Robert Mil­stead Jr., and Air Force Lt. Gen. Dar­rell Jones.

The strain of decade-long war is wear­ing on sol­diers and their fam­i­lies, Bostick said.

“The most-trag­ic indi­ca­tor of this stress is the his­tor­i­cal­ly high num­ber of sui­cides that we have expe­ri­enced in recent years,” he said.

The past year has seen a slight decrease in sui­cide inci­dence among active-duty sol­diers, which offi­cials cred­it to pro­grams and pol­i­cy changes that began in March 2009, Bostick said.

Army research shows those pro­grams help mit­i­gate stress for active-duty troops, but reserve com­po­nent sol­diers don’t have access to the same sup­port net­works or the over­sight of as full-time chain of com­mand, he said.

“This is a com­plex prob­lem; it has no sim­ple solu­tion,” Bostick said.

DOD and Army lead­ers are work­ing “to bet­ter under­stand the prob­lem, and then to get the lead­er­ship involved at every lev­el in what we learn from those con­ver­sa­tions, what we learn from our month­ly reviews of these sui­cides,” he said.

Navy sui­cide rates declined from 2009 to 2010, but the cur­rent rate shows an increase over last year, Kur­ta said.

The Navy’s sui­cide pre­ven­tion pro­grams com­bine stress con­trol, psy­cho­log­i­cal health out­reach to Reserve sailors, health pro­mo­tion and fam­i­ly readi­ness, Kur­ta said.

“We view sui­cide pre­ven­tion as an all-hands-on, all-of-the-time effort,” he said. “It involves sailors, fam­i­ly mem­bers, peers, and lead­er­ship.”

Kur­ta cit­ed the Navy’s Coali­tion Of Sailors Against Destruc­tive Deci­sions, a peer-to-peer men­tor­ing pro­gram that “empow­ers our most-junior sailors to make respon­si­ble deci­sions and to reach out to their ship­mates in need.”

The pro­gram now includes 200 chap­ters across the Navy, he added.

Mil­stead said the Marines saw a near­ly 30-per­cent decrease in sui­cides dur­ing 2010, from 52 to 37, and num­bers so far this year are still low­er.

Marine Corps offi­cials hope the down­ward trend con­tin­ues, but will con­tin­ue to aggres­sive­ly improve sui­cide pre­ven­tion pro­grams at all lev­els and focused on encour­ag­ing ser­vice mem­bers to seek help ear­ly, he said.

“As Marines, we pride our­selves on tak­ing care of our own,” Mil­stead said. “A Marine strug­gling emo­tion­al­ly is a wound­ed com­rade, and we don’t leave our wound­ed on the bat­tle­field.”

He said the Marines found that the “leader-to-led ratio” before, and more crit­i­cal­ly after, a deploy­ment could affect sui­cide attempts.

“We quick­ly dis­cov­ered that it was on the back­side of that deploy­ment where it was even more impor­tant, as we’ve come to call ‘the dark side,’ for at least 90 days when a young Marine returns from a deploy­ment and [has] to dance with some drag­ons of things that he’s seen,” Mil­stead said.

Jones said the Air Force total strength includes 693,000 uni­formed and civil­ian mem­bers. This year, 56 of them — offi­cer, enlist­ed and civil­ian — have tak­en their own lives, he said.

“Although that num­ber of sui­cides is low­er than the same peri­od last year, it is still a major area of con­cern for our force, as it sends rip­ples across the fam­i­ly, the unit and the com­mu­ni­ty,” he said.

Air Force offi­cials have “redou­bled” post-sui­cide care at the unit lev­el and enlist­ed the aid of health care pro­fes­sion­als to devel­op a com­pre­hen­sive guide to help lead­ers respond to sui­cides with­in their ranks, Jones said.

“We are keen­ly aware that a proac­tive response by unit lead­er­ship plays a role in pre­ven­tion of addi­tion­al sui­cides and attempts,” he said.

The Air Force recent­ly devel­oped the Com­pre­hen­sive Air­men Fit­ness pro­gram, focused on bol­ster­ing phys­i­cal, men­tal, spir­i­tu­al and social fit­ness, Jones said.

“We know that as soci­ety changes, so do our air­men, and it is impor­tant that our strate­gies for being resilient air­men con­tin­ue to be as resilient and as flex­i­ble as our force,” he added.

Wood­son said while DOD and the ser­vices have a num­ber of sui­cide pre­ven­tion pro­grams in place, it’s crit­i­cal to devel­op mea­sures show­ing which pro­grams are most effec­tive.

“One of the things we have to real­ly be care­ful [about] in a resource-con­strained envi­ron­ment is that we don’t fund pro­grams that are not effec­tive, and [also don’t] allow oth­ers that would be effec­tive to with­er on the vine,” he said.

Some approach­es have been proven effec­tive, Wood­son said. Ser­vice mem­bers in cus­tody fol­low­ing legal dif­fi­cul­ty are at high­er sui­cide risk, so eval­u­at­ing that risk is impor­tant. Also, peer-to-peer pro­grams seem to work, as does access to high-qual­i­ty men­tal health care by pro­fes­sion­als expe­ri­enced in eval­u­at­ing and treat­ing sui­cide risk, he said.

DOD’s strat­e­gy is to place men­tal health spe­cial­ists adept in screen­ing for sui­cide risk with­in mil­i­tary units, and ensure “high-end spe­cial­ists” can then fol­low up to treat more com­plex prob­lems, Wood­son said.

“It’s not only a ques­tion of num­bers; it’s a ques­tion of the right dis­tri­b­u­tion of spe­cial­ists to make sure we get the job done,” he said.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)