A couple of weeks ago, Danya hosted the 2012 Clinical Preceptorship Training Conference for Navy substance abuse program directors, counselors, and our clinical supervisors at a Navy base in San Diego, CA. Sharon Foley, our Project Director, asked me to conduct a training session on “Suicide Prevention in the Military,” and I was assisted in collecting information and literature by Sharon and several other Danya staff, including Nancy Bateman, Jessica Tercha, Lindsey Martin, and Karen Gavin-Evans. I’d like to share a few of the highlights from the presentation
Over the past several decades, suicides in the military were generally at the same rate as in the general U.S. population, reaching about 10 per 100,000 people around 2003. However, since that time, general population suicides have gone up slightly to 12 per 100,000, while suicides in the military have exceeded 18 per 100,000. Here are a few other related statistics:
- Every 14 minutes, someone in the United States dies from suicide.
- Nearly 1 million people attempt suicide each year in the United States.
- In 2010, more U.S. soldiers killed themselves (468) than died in combat (462).
- This year, 2012, military suicides are averaging one per day.
The reasons for increasing suicides in the military are multifaceted, but more frequent deployments with shorter recovery periods in between are critical factors, as well as family and relationship problems back home. In addition, the increased use of improvised explosive devices (IEDs) and suicide bombers creates an environment of constant stress and danger, which is exacerbated even further in Afghanistan, where the terrain is so mountainous and the roads so bad that troops are more vulnerable to being ambushed. These are just a few of the many factors that increase stress and pressure.
In assessing suicide risk, there is a wide range of personal, clinical, and protective factors that must be considered, but it begins with recognizing the warning signs and taking them seriously, including:
- Increased alcohol/drug use
- Reckless or risky behavior
- Withdrawal, agitation, sleep issues
- Dramatic mood changes
- Rage and anger
The main challenge in addressing the prevention of suicide in the military is overcoming the fear of stigma of having mental health problems. Soldiers, sailors, and marines, both male and female, are trained to be tough and often have to maintain a “macho” culture for survival in the battlefield. It is not easy to admit to themselves or others that they are depressed, stressed-out, anxious, or afraid. They don’t want to be seen by others as “weak,” “defective,” “disabled,” or worse, as “malingering.” So they keep these feelings inside or act them out through drinking and drugs, and it is extremely hard for them to ask for help when they need it.
We also discussed suicide risk assessment, including assessing the lethality of methods considered, as well as interventions and referrals. The key is to listen carefully and be caring and supportive, while ensuring an immediate referral to mental health professionals for those at-risk. Finally, we discussed dealing with the aftermath of a successful suicide. As you can imagine, this can be devastating for survivors, both in the field and at home.
Preventing suicide in the military, as well as among veterans who have served in battle, is an urgent and critical challenge. Overcoming stigmatization, identifying problems early on, and intervening in the most effective ways are imperative. But as stated by Capt. Paul S. Hammer, Director of the Naval Center for Combat and Operational Stress Control, everyone can play an important role:
“One big thing that people neglect about suicide is the power of little things. So often we see that many people were dissuaded from hurting themselves by someone who made a very minor gesture that turned out to be huge.”