The Army’s Response to Rise in Suicides, PTSD

Today I participated on a U.S. Army-sponsored conference call to discuss their reaction to data showing that 115 active soldiers took their own lives last year (nearly double the rate from 2005) and approximately 17 U.S. veterans commit suicide each and every day (significantly more than reported to Congress last year). Statistics also show a nearly 50 percent jump in new posttraumatic stress (PTSD) cases last year when 13,951 service members were diagnosed with combat stress, compared to 9,549 in 2006.

The Army says it is working hard to improve access to mental health care among the troops, to reduce the stigma often attached to seeking counseling, and to train and educate soldiers to recognize signs of stress in themselves and their comrades. But senior officers also acknowledge there is much more work to be done to help soldiers deal with personal problems compounded by the stress of combat.

The challenge is familiar. The military is under extreme stress for the prolonged deployment in Iraq, which nobody planned for and which the military was clearly not prepared for. Stigma related to seeking treatment for any mental health concern — even combat-related PTSD — remains the biggest obstacle to helping reduce the number of suicides. The Army has started the process of decreasing the stigma and negative reinforcements by changing the security clearance questionnaire where respondents no longer have to indicate a mental health issue if related to their military duties.

But it’s a drop in the bucket in terms of the real life stigma experienced in individual units and under C.O.s. Seeking mental health treatment while in active operations is akin to signing your own declaration of, “I have no interest in career advancement in the Army.” It remains a sign of weakness and discrimination. Until Army leaders are held responsible for the repercussions carried out under their commands, little significant change will occur.

On today’s call were three U.S. Army representatives: Col. Elspeth Ritchie: psychiatric consultant to the Army Surgeon General; Lt. Col. Thomas E. Languirand, Chief, Command Policies and Programs Division; and Chap. (Col.) Charles D. Reese, Office of the Chief of Chaplains. Col. Elspeth Ritchie did most of the responding. Today’s call also covered questions asked by other military bloggers:

1. Can there be an improvement in the Army’s crisis resources? Something better than just going to ER and told to go home if not actively suicidal? The answer was basically, no, not at the moment.

2. How about more inpatient programs made available to military personnel? The representatives basically said that nothing is available right now, but they are looking at something in-between once a month and inpatient — an intensive outpatient program. This sounded like something akin to a day treatment program for veterans and would be a welcomed addition to the treatment options open to vets.

3. What about all the alternative treatment programs mentioned in the news at the end of March? Virtual reality, yoga, etc. They are just in research phase right now and not widely available until proven their worth.

4. A question was asked about some recent legislation introduced in Congress that would expand mental health care to military vets. Col. Ritchie responded, “Anything that can improve access to care, we should take advantage of. We need to expand our network of tri-tier providers.”

5. How will Army remove PTSD stigma, given its long history within the military? “Part of this is education, we did this major training where we taught every soldier about TBI (traumatic brain injury) and related issues. We’re looking at policies that discriminate against mental health. The security question, for instance, is one change we’ve undertaken,” replied Col. Ritchie. She also emphasized the importance of strong leadership ensuring such stigma is not tolerated within their units.

It was a very short phone call (the coordinator kept emphasizing how little time we all had; it lasted about 25 minutes in length), and I felt like we could’ve easily had another 30 minutes of questions to ask and explore. But I do appreciate the U.S. Army’s willingness to engage with bloggers and allow them to pose questions regarding some of these chilling statistics.

Col. Ritchie also noted some interesting statistics about the availability of mental health professionals overseas which I’m not sure are widely known. There are approximately 200 behavioral health providers (e.g., military therapists) in Iraq and 30 in Afghanistan. That’s about one therapist per 600 soldiers versus one therapist per 375 Americans in the U.S. civilian population. Given the significantly greater stressors and risks for mental health concerns a soldier in active military duty is likely to experience, these numbers seem backwards. There should be twice as many therapists available to soldiers are there are to civilians, but there isn’t today.

One thing Col. Ritchie emphasized is the Army’s recognition of the suicide and PTSD rates as problems and their current challenges in resources. They know these are issues and are working to correct them. We hope they do.

And we hope the military leadership recognizes that this isn’t just an urgent issue in the services, but something that could just as easily snowball into a crisis of significant concern. Without real efforts made now to help stop this trend, we could see next year’s suicide rate double again in the active service. It’s a datapoint we’d rather not have to document.