Suicides by active-duty troops and veterans are at levels that would have been unthinkable a generation ago. Each day, on average, a current service member dies by suicide, and each hour a veteran does the same.
In response, President Obama signed the Clay Hunt Suicide Prevention for American Veterans Act in February. The act aims to make information on suicide prevention more easily available to veterans; it offers financial incentives to mental health professionals who work with vets; and it requires an annual evaluation of the military's mental health programs by an independent source.
The law is commendable, but it won't come close to ending military suicides. That would require radical changes in the policies, procedures, attitudes and culture in two of our biggest bureaucracies: the departments of Defense and Veterans Affairs.
Fifteen years ago, the suicide rate among patients in a large HMO in Detroit was seven times the national average. Its leaders decided to try to end suicides — not just reduce them but end them. In four years, the incidence of suicide at the HMO was reduced 75%; with more tinkering, the rate went down to zero, and has stayed there, at last count, for 2 1/2 years. The difference was an all-out commitment to the cause.
Every time a patient sought care, regardless of the reason, he or she was assessed for suicide risk. Every employee who came in contact with patients was rigorously trained in suicide prevention. Specific interventions were established for each of three risk levels.
The HMO also implemented measures to provide timely care by enabling patients to get immediate help through email with physicians, to make same-day medical appointments and to get prescriptions filled the same day too.
A similar commitment by the military could achieve dramatic results, at least among active-duty troops. These troops are in the system now, their activities are being monitored regularly, so there are plenty of opportunities for assessment and treatment.
If the military followed the Detroit model, all troops would be evaluated for post-traumatic stress and suicide risk when they return home, not just those who ask for help. Evaluations would happen more than once; they would be in person and one-on-one, not with written questionnaires. In addition, families would be interviewed, separately and confidentially.
And treatment and claims would be expedited. Veterans shouldn't have to wait a year or more to receive healthcare or have their claims processed.
Then there is the matter of stigma. It's not the military's responsibility alone to destigmatize psychological problems, but there are steps the military can take.
Service members with PTSD who are able to manage it should be strongly considered for promotions just as though they had recovered from physical wounds. Their ability to overcome mental injury should be recognized, so it inspires others.
Purple Hearts are awarded to soldiers who suffer a serious physical wound in combat; they should also be awarded to those who suffer serious mental health injuries in combat. Injuries are injuries and none should be minimized.
Finally, just as good-conduct medals and combat awards are bestowed on troops, so should commendations be given when soldiers recognize that their comrades need help and act on their behalf.
This is just a start. To keep its troops mentally healthy, the Defense Department must reduce the number and duration of combat deployments and do more to prepare troops for assymetrical warfare. It must help them adjust to life when they come home — with jobs, housing, loans and legal assistance. It must enforce, not just approve, a policy of zero tolerance related to sexual harassment and assault.
Each element has a price, and collectively the cost will be astronomical. We must be prepared to pay it if we are sincere in our commitment to support our troops.
John Bateson was executive director of a nationally certified suicide prevention center in the San Francisco Bay Area for 16 years. His latest book is "The Last and Greatest Battle: Finding the Will, Commitment, and Strategy to End Military Suicides."