Saving our warriors from themselves

As the nation marks Memorial Day, here is a statistic that offers sobering insight into the lives of the military men and women who have, over the decades, sacrificed so much for so many: Last year, 349 active servicemen and women committed suicide, more than the number who died in battle and the highest number in a decade of war.

The incidence of suicide has also risen among veterans. A report released in February by the Department of Veterans Affairs estimated that 22 veterans committed suicide in this country each day in 2010. That’s slightly higher than in 1999, when the estimate was that 20 veterans a day committed suicide.

For the departments of Defense and Veterans Affairs, this is a grim epidemic that has eluded easy or obvious fixes. Experts say the first step toward preventing suicide is knowing who does it, how they do it and why. The military does a good job of collecting those statistics. Since 2008, the Department of Defense has issued an annual Suicide Event Report that lists in meticulous detail the number of suicides and attempted suicides and the circumstances surrounding the deaths.

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The second step, of course, is getting those people at risk for committing suicide to seek help. That is a huge task. Mandatory screening and counseling have not done a good job of identifying suicidal service members and persuading them to talk about their problems. Many worry that doing so will affect job promotions or stigmatize them in some way.

According to the 2011 Suicide Event Report, most of the military personnel who committed suicide that year did not confide their plans to anyone and did not have a known history of a mental health disorder. Half of them had experienced a failed personal relationship, and a substantial number were coping with a serious work-related problem. But, perhaps surprisingly, most were not actively deployed and in a combat zone. They were working at their home bases. More than half had never been deployed, so their troubles were not the result of battlefield stress or trauma.

Elspeth Ritchie, a psychiatrist and retired Army colonel who worked as a consultant to the Army surgeon general, speculates that some suicides on home bases may be related to the fast pace of deployment of troops, leaving those who remain feeling disconnected from their units and adrift.

Recognizing and responding to signs of anguish or stress are undoubtedly difficult on busy military installations. But ensuring that mental health providers are readily, unobtrusively accessible will save lives.

Meanwhile, researchers believe other ailments — such as constant musculoskeletal pain or multiple traumatic brain injuries — could be factors in military suicides. Vigilantly screening for brain injuries could identify those at risk. And coaxing someone into treatment for physical pain may lead to the counseling he or she also needs. Some military psychiatrists are using acupuncture as a path to counseling.

Finally, the military needs to respond forcefully when service members show signs of breaking down. Those under severe stress or otherwise displaying suicidal tendencies should be forced to surrender their firearms, at least until they can receive help. As is true in civilian life, most military suicides are committed with a gun.

The situation for suicidal veterans is less advanced. In general, those needing help can be hard to track down. If they don’t avail themselves of services at veterans’ health centers or apply for benefits, they are not even in the system. But according to veterans’ advocates, they are out there. In a recent survey of new veterans by the Iraq and Afghanistan Veterans of America, 45% knew a veteran who had attempted suicide and 37% knew one who had committed suicide.

But it can take weeks to get mental health treatment at veterans’ health centers. Such delays are harmful in all events but can be fatal in these cases.

Neither the military nor the Department of Veterans Affairs can stop service members and veterans from committing suicide, but they must find ways to reach out to them, to make them aware of the services that are already offered and to dispel the belief that it’s disgraceful or weak to need help. To the contrary, it’s smart and brave to seek it.