While the United States’s foreign wars wind down, the body count at home keeps rising. The Pentagon said this week there were 349 suicides by active-duty members of the armed services in 2012, as opposed to 311 combat deaths.
Before you jump to conclusions about the plight of battle- traumatized veterans failing to readjust to life stateside, consider this astounding fact: More than half of troops who killed themselves had never deployed from the U.S., and 85 percent never saw combat. Although caring for those returning from battle remains a priority, the military needs to better monitor the mental health of all service members.
In part, the military is a victim of a broader social phenomenon: The U.S. suicide rate soared to 12.4 per 100,000 Americans in 2010, from 10.4 in 2000. The military’s rate is almost double the national average, which isn’t hugely surprising in that the services are disproportionately male, and men are far more likely than women to take their own lives. (Indeed, a 2011 Rand Corp. study that controlled for demographics found that the armed services had a significantly lower adjusted suicide rate than the general population.)
And there are good explanations for why the campaigns in Iraq and Afghanistan have affected the mental health of far more troops than have actually fought. Eleven years of war have diminished continuity in units; officers and senior enlisted men move more frequently and have less opportunity to connect with green troops. The newcomers can easily feel isolated and unworthy of serving alongside those who have survived on the battlefield.
According to the Army’s former top psychiatrist, Elspeth Ritchie, the bases with units deploying most rapidly had the greatest suicide problems. And rates are significantly higher in the Army and Marines, which have done the bulk of the fighting abroad, than in the Air Force and Navy.
The Pentagon’s response to the crisis has ranged from symbolic — a one-day servicewide “stand down” in September for suicide-awareness training — to significant, setting a goal of putting one enlisted behavior-health specialist in each battalion and embarking on a $50 million study of suicide with the National Institute of Mental Health, the largest ever undertaken. Congress allocated $40 million to enhance suicide-prevention programs at the Pentagon and Department of Veterans Affairs, and wisely included a measure in this year’s defense authorization act allowing commanders to ask their troops about any private firearms they own.
What more can be done? There is little chance of making the warrior culture, with its disdain for weakness, more receptive to the presence of mental illness. More than two-thirds of those who committed suicide never told anyone of their intent, and most of those who did told family members, not fellow troops.
Yet the very things that make the military different from civilian life — daily structure, constant oversight by superiors, close contact with a tight-knit group of colleagues, constant access to health care — should provide avenues for detecting and treating mental-health problems.
For example, troops are screened for depression and other problems before and after deployments. Unfortunately, this relies entirely on self-reporting. The military should also include observable variables known to reflect a person’s mental state, including assessments of reaction times and responses to images.
The place where mental-health issues are most likely to be caught is within the squad or platoon, where troops and their superiors have the most direct contact. So junior officers and sergeants need more training in spotting problems and ensuring that those who seek professional help are not stigmatized.
This should be coupled with increased attention to nonpsychological warning signs. Data collected from 2010 showed that half of all service members who committed suicide were struggling with a failed personal relationship and 44 percent had looming legal or administrative problems such as disciplinary punishments, or had recently been denied promotion.
As for troops who have been traumatized by service, new therapies are in the offing. Preliminary results from a multiyear University of Utah study involving service members who have attempted suicide or talked of it indicate the Pentagon should move away from its emphasis on long-term hospitalization and outpatient treatments. According to David M. Rudd, the project director, very brief cognitive-therapy treatments reduced suicide attempts “by almost 70 percent relative to treatment as usual.”
It’s hard for any military force to admit it’s in a quagmire, so give the Pentagon credit for the money and attention it’s spending to investigate its new No. 1 threat. All the data in the world won’t help, however, unless the men and women in uniform get the day-to-day monitoring and assistance they need.