I haven't read the report yet, but I am going to guess that the media narrative will be wrong. In politics this is bad, but for suicide, it is dangerous. The lede in the McClatchy story I read this morning:
"A new Army report has found that inattention to rising rates of drug abuse and criminal activity among soldiers and not repeat deployments to Iraq and Afghanistan is responsible for the record-high levels of suicide among troops."
First, that it is even possible to attribute a suicide to a single factor is pernicious. It is impossible to say one factor is responsible while another is not. I'm very interested in finding out how the report dealt with this. Hopefully, more responsibly. Second, drug abuse, criminal activity and suicides are symptoms of the problems soldiers have. Drug abuse and criminal activity do not cause suicide. People experiencing severe problems are more likely to do all three.
While the Times headline is idiotic, the article itself is better. But the lede is atrocious:
"commanders are ignoring the mental health problems of American soldiers and not winnowing out enough of those with records of substance abuse and crime"
So keeping those with mental health problems in the Army is causing them to commit suicide? Kicking them out is only a strategy to keep the Army's suicide rate down. I think I'm on very solid ground saying that suicidal soldiers are much more likely to attempt suicide after they are discharged (un-honorably?) then if they remained enlisted. Again, I hope the report doesn't actually say this, we'll see.
The key factoid getting all the focus is the relationship to time of enlistment and number of deployments:
"the vast majority of soldiers who killed themselves — 79 percent — had never been deployed to a combat zone or had been deployed just once." Note that the rate for "first termers" is 60%. This is consistent with the fact that the first year has the highest suicide rate, and it goes down (probably sharply) after that year.
I'm not saying that deployment to war causes suicide to increase either. I'll read the report and think about it. My guess is that lower recruiting standards is the ultimate cause. But the media is seriously screwing up this vitally important issue.

So everyone knows, I've never been in the military. I'm bipolar type II and I attempted suicide once. I've been stable with the help of family, therapy and medication for over 5 years now.

Both articles' headlines mention "blame". I'm guessing almost every story about the report will use that word. In the context of suicide, it is a terrible word. A suicide should not be blamed on anything, especially not some personal behavior such as drug abuse or criminality. "If he wasn't on drugs, he wouldn't have killed himself" Well, maybe. But it's ignoring the root cause and thus the chance to make the situation better for people who might attempt suicide. Getting somebody sober is a necessary step for a stable life, but it is not sufficient.

Far more accurate and helpful is the term "explain." These suicides and the problems these people had need to be explained. General statistics like percent of suicides on drugs or in their first year of enlistment are a start, an idea of what to explore for a solution, but they don't explain a single suicide. This is obviously very hard, but the Army must have an incredible amount of information about the lives of those that succeed in killing themselves. I hope the report dived into these details, but first articles and highlighted quotes don't give me hope that they will be talked about much in the general media.

From the McClatchy story:

"While commanders may struggle to mentor young soldiers, they must also recognize when the best thing for the Army is to seek to have a soldier returned to civilian life."

"The report also found that the Army needs to provide at least 36 months time at home between combat deployments — something it won't be able to do for years. That means that soldiers and their families will face unusually high level of stress, even after a soldier has returned from a deployment — and that the stress may continue "indefinitely," the report found."

I've purposefully mentioned attempted suicide here to emphasize that there are a lot of hurting people out there still alive, both in the military and out.

"In 2009, 160 soldiers committed suicide and another 146 died by other violent means, such as murder, drug abuse or reckless driving while drunk. Another 1,713 attempted suicide."

That means over 10 soldiers attempt suicide for every success. What is the Army doing for those thousands of enlisted soldiers who must have serious problems?

http://www.mcclatchydc.com/2010/07/29/98364/army-suicides-poor-leadership.html

The Army's ability to maintain accountable leader's seems to be a problem. The next task for the VCSA will be to figure out how you can train and promote leaders who will accept responsibility for their inactions on and off the battlefield without making them risk adverse to taking any actions.

One way might be to hold them responsible for everything their unit does and fails to do like we once did. Or not...

Sorry, I hope I'm not discouraging more comments, but I'm driven to talk about this. I'll just read the report after this.

The rest of the news headlines were almost all "blame" free. So I was wrong there. The report press release never says it, and has this remarkable statement in it: "Report findings indicate that there are no universal solutions to address the complexities of personal, social and behavioral health issues that lead to suicide."

If only the journalists would all include this caveat, even buried at the end. These two items make the NYT story look very bad in comparison. Bumiller seems to have selectively picked the Chiarelli quotes to further her angle that is dangerously close to "blame the victim".

"General Chiarelli said he did not want to typecast, “but I think it’s fair to say in some instances it would be a soldier that’s possibly married, couple of kids, lost his job, no health care insurance, possibly a single parent.” Such a soldier, General Chiarelli said, “is coming in the Army to start all over again, and we see this high rate of suicide.” " ...

"Over all, General Chiarelli said, “The United States Army is a fully capable force comprised of 1.1 million men and women,” and “we are in fact expending much, much effort on a very, very small portion of this population.” "

These are two of the last three paragraphs, but back at the 3rd, Bumiller uses a blame quote, but in a way that goes against the grain of the narrative, and seemingly against the report itself:

"“For us to blame this thing just on the war would be wrong,” Gen. Peter W. Chiarelli, the vice chief of staff of the Army, said at a news conference about the report. “That’s not what we’re trying to do here.” Nonetheless, General Chiarelli said that he believed — but could not prove statistically — that the overall Army suicide rate had been driven up by the 21 percent of suicides committed by soldiers with multiple deployments. “That has just always been my concern, that they may be it, that may be the reason,” he said. “But I don’t have any data that I can tie that to.” "

So the report leader says he thinks that something not supported by any facts and directly contrary to the developing narrative (based on the report) might be the cause of the rising numbers? I sure hope somebody follows up on this (hint, hint) Okay, I'm out.

All of the measures that big army is forcing on us pointy end guys are not working and are not going to work. We have continuously droped the standards for enlistment while asking more of our soldiers over the last decade. This combined with a younger generation that is mentally, physically and educationally unfit for military service is causing this spike in suicides. Nationally suicide rates are rising at alarming rates for 19-25 year olds. This is a culture issue and not something specific to the military. The military rates are significantly lower than than national averages, but we have knee jerk disease in the military. We have gotta fix this now yell the senior leaders!! So we bring in all the soldiers and lecture them then we bring in the all so useful (sarcasim) Chaplain corps to save us for this problem. Suicide is not going away until we fix the cuture in the US, nothing leaders do will prevent those soldiers aho decide that death is preferable to life from ending themselves. WHat we can do and have been doing is pay attention to the troops. My experience is that older NCOs and "hardcores" are causing a fair bit of problems by ignoring or in some cases riding soldiers with issues. However filling out more reports and having more mandatory classes is not the answer, better screening at MEPS and a softening of the military culture is for now.

PREVENTING SUICIDE
A RESOURCE FOR MEDIA PROFESSIONALS
http://www.who.int/mental_health/media/en/426.pdf

It seems to me that sensational news on a suicide that I perceive emotionally as local, or closely connected to my identity group, is going to be a stronger stimulus, in terms of visualizing, fantasizing, rehearsing and finally acting out.

It shouldn't be that hard for Big Army / Marines to use deception-resistant techniques to screen for suicide (or criminal) proclivities, in the military recruitment process. We do want to be careful who we give firearm training to, who we inculcate with 'battle mind". While we're screening, there's no reason to accept the training of a McVeigh/Nichols, John Allen Muhammed or Lee Harvey as a cost of national defense. (I put Maj. Hassan MD in a different category, since he wasn't recruited or trained as a warrior, at least not by our side.)

Recruitment in demographics like 30 year olds with children, or troubled 18 year olds that for whatever reason have trouble hanging out long enough to graduate HS, does in fact stem from ground force overdeployment and attrition, thru 10 years of grossly mismanaged overseas wars. Asserting otherwise ought to discredit the witness.

Does anyone commenting here have personal experience with the current wounded warrior care system? If you have not been living in one of these units (WTU, WTB, WWBN) with the invisible wounds of PTSD and TBI, then you really can't believe everything you see in print. Just ask any of us who have been fighting for the life of our loved ones trapped in these hell holes. One of these wounded warrior units destroyed my Marine. He was NOT accepted into the Corps via "waiver". He was NOT a juvenile delinquent. He wanted to be a Marine from the time he was 4 years old. He was planning to be a career Marine, evidenced by his reenlistment, training, acceptance, and deployment with Special Forces. He served three tours, watched plenty die, came close to death himself, probably had to kill in the name of the USA, and has lost friends to suicide. He lived by the motto Semper Fidelis. Unfortunately, he found that motto to be one-sided when he arrived at WWBN.

I am really getting tired of hearing people say, "Well, they enlisted. What do they expect?" I'm tired of hearing that the wounded warrior units are just made up of malingerers and drug addicts that need to be removed from the war machine. Did it ever occur to anyone to take a look at who these men were prior to injury? Did it ever occur to anyone that once stripped of dignity, people often live up to the expectations of others? If we tell them they are worthless, it won't be long before they believe it themselves.

I now have to try to restore the honor and dignity that was stolen from my combat veteran. The problem with that....I'm his mom and I didn't take it away from him in the first place.

Please don't make judgments if you have no personal experience with the issue. I now know three who have taken their lives. Suicide was seen as the only ticket out.

This issue highlights the absolute necessity (or in military terms - duty) for strong empathetic creative leadership in this complex enviornment - these Soldier issues are complex and our leadership needs to address them with the same level of rigor and resources that we do with any other complex issue/operating environment....

The Army has made making recruitment goals a key priority similar to pre-crash mortgage bankers making closing of large numbers of mortgages the primary goal. If quantity is our primary goal then that’s what you will get at the expense of quality. The mortgage industry has by necessity cleaned up its act and now has instituted more rigorous standards to qualify for a mortgage. The Army needs to do the same and tighten up standards for entrance. Too many recruits into the military are immature, undereducated, socially alienated, physically out of shape, and with drug and criminal proclivities. The Army would have a better grip on these issues if they would award the recruiter with recognition for the quality of his recruits not the quantity of them. One of the best determinates of recruit success is his level of academic achievement, his participation in school athletics, and rigorous drug screening. Also, junior enlisted should not be permitted to marry until they have successfully served in the ranks for a few years and demonstrated their responsibility, violators should be dishonorably discharged. Most 18 to 22 year old’s do not have the mental maturity to manage both families and finances and thus add increased stress to their lives by doing so. If the Army must become smaller to get a better recruit then so be it. A smaller Army of higher quality people will be valued higher by the officers and taken care of accordingly.

JD, I agree that recruiting should be about quality, not quantity. My Marine may very well be a victim of substandard recruiting...not because he himself was "immature, undereducated, socially alienated, physically out of shape, and with drug and criminal proclivities", but because he's been forced to serve alongside those who fall into that classification. He's not married so he doesn't have that strike against him either.

I don't agree with this statement. "A smaller Army of higher quality people will be valued higher by the officers and taken care of accordingly."

Every leader should place equal value on each one under his leadership. A good leader should consider every single person to be of the highest value. That is the whole problem with the officer/enlisted relationship and the cause for poor care within our wounded warrior units. The discrimination and bias is worn on the sleeves of leadership and everyone can see it a mile away. The highest ranking officer's life is not more valuable than the private that just took his oath. Maybe to you, but not to that private's family.

How can one lead when he has not first walked the path before him? Every officer should be made to enlist for four years before he can go to OCS. Then he would have a real knowledge of what it looks and feels like from the other side. He would be a better leader because of time spent and lessons learned in the lower ranks. His maturity level would be more developed because he would have put in 4 years of college as well. At the age of 26, he might just be mature enough to begin learning how to lead.

A good leader knows how to build self-esteem and character in his soldiers. He also recognizes that it is his responsibility to do that. His men will only be as valuable as he makes them. His treatment will define who they become. If a soldier is told over and over that he is worthless, he will eventually begin to view himself that way. If the lowest ranks do not feel that leadership respects them, they will not respect the leadership.

A good leader is humble. He never views himself as more important than the lowest ranking soldier. A good litmus test for arrogance might be developed. Those who fail should be asked to find another line of work.

All of this rings true in the civilian world as well. We may not be trained to go to war, but we do have to live the human existence.

When the Army tightens up their entrance standards, they should start with their expectations for leadership. A good leader can dramatically change the life of a mediocre recruit.

"Last year I visited six installations with a team for the sole purpose of looking at suicide prevention efforts in the force. The result of that eye-opening experience prompted an Army campaign to rebalance health promotion, risk reduction and suicide prevention programs and services."

So after looking at suicide prevention, he determined that the Army needed to increase health promotion and risk reduction. Great, but does "rebalance" mean less resources to actual suicide prevention? While this is unlikely, the focus does seem to have changed. As the letter says, " "

The issue here is that high-risk equated with criminal offenses and alcohol/drug abuse. Again, great, soldiers need help avoiding these situations, but that doesn't have a direct connection with suicide prevention. Criminal offenses are completely unrelated to suicide attempts. I would say suicidal soldiers are much less likely to break the law than the general population of soldiers. Again, alcohol/drug use, which is self-medication for suicidals, is correlated to suicide but not causal.

The report says in 2009 there were 57,503 criminal offenses, 16,997 drug/alcohol offenses and 1,713 suicide attempts. Unless you are screening all criminal offenses or just drug/alcohol offenses specifically for danger of suicide, then focusing on these high-risk behaviors will not help suicide prevention at all. I'm just at the start of the report, so I hope I'll find out suicide screening is happening.

"What we witnessed firsthand were real indicators of stress on the force and an increasing propensity for Soldiers to engage in high risk behavior. This report validates a central conclusion of that trip: risk in the force cannot be mitigated by suicide prevention alone."

Same thing here, looking at suicide prevention, the report changes its focus to high risk behavior.

Whoops, missed two things. Chiarelli's name and the empty quote is "What we focus on gets done."

"Some form of high risk behavior (self-harm, illicit drug use, binge drinking, criminal activity, etc.) was a factor in most of these deaths."

For the suicide deaths (239 active duty and Reserves), what does "factor" mean? The first is a clear indication of suicide risk, while the others in and of themselves are not.

"Latest accounts estimate that approximately 106,000 Soldiers are prescribed some form of pain, depression or anxiety medications. The potential for abuse is obvious."

People don't abuse depression medications. The issue is getting depressed people to consistently take them. It is very hard to accept that you can't fix yourself without medication. Within the "Army of one" culture, it must be a huge problem. I hope this is recognized. Some pain and a few anxiety medications can be abused. But assuming active duty soldiers get prescriptions written and filled by Army personnel (and are very unlikely to feed an abusive habit), how can soldiers get more than they need in order to abuse prescription drugs? It is not at all obvious how abuse happens in the Army.

It's not all bad, of course: "We must identify our Soldiers who are at-risk, mitigate their stress and, if necessary, personally intervene to assist them. By working together we can provide holistic care for help-seeking Soldiers, while acting firmly to reduce the high risk population. We must increase health care access, reduce the stigma associated with help-seeking behavior and implement the Army’s Pain Management Plan to increase the health of the Force."

But the parts that bury suicide prevention underneath the much more common high-risk behaviors are not good: "We must ensure that Soldiers who cannot adapt to the rigors and stress of this profession find sanctuary elsewhere for their own wellbeing and for that of the force." Criminal activity and street drug abuse, yes, absolutely right. Any mental health problem, absolutely wrong. Separation is just to avoid another Army statistic and is likely the worst outcome for the soldier.

"No one could have foreseen the impact of nine years of war on our leaders and Soldiers."

"The cumulative effect of transitions borne of institutional requirements (professional military education, PCS moves, promotions) coupled with family expectations/obligations (marriage, child birth, aging parents) and compounded by deployments is, on one hand, building a resilient force while on the other, pushing some units, Soldiers and Families to the brink." both p. 1.

The first is just asinine and makes me want to say FU to the writer. The second one flies, only if you define "resilient" as not on the brink. For both, if you actually think nine years of war could have anything other than a devastating effect on soldiers' lives, you're an self-deluded idiot or a complete asshole.

Top of page two has a footnote: "At 24 years of age, a Soldier, on average, has moved from home, family and friends and has resided in two other states; has traveled the world (deployed); been promoted four times; bought a car and wrecked it; married and had children; has had relationship and financial problems; seen death; is responsible for dozens of Soldiers; maintains millions of dollars worth of equipment; and gets paid less than $40,000 a year."

That is nuts. And who decided to include maintains millions of dollars worth of equipment? Is that supposed to be stressful?

"When the economy declines, there is an increased risk for suicide." Absolutely, and the report states this to back it up:

"General [National Suicide Prevention] Lifeline calls increased from 381,316 in 2007 to 501,562 in 2009, while the Veterans Hotline increased from 20,853 to 125,625 during the same period."

32% increase in the general population vs. 602% in the veteran population. No comment is made on this disparity. The report just moves on to how hard it is to track actual suicide deaths.

Page 16 has a chart that compares the general population to each service. Since 2001, the general population rate has stayed very steady, around 19 per 100,000 (adjusted for age and gender to match DoD profile). The Army, Navy and Air Force all started 2001 at about half that, 10 per 100,000. Starting in 2004, the Army's rate steadily increased until it passed the general rate in 2007 or 2008. It is still increasing. Navy and Air Force have gone up only slightly, to around 12 per 100,000 in 2009. The Marines started higher, but was highly variable year to year. However, it is now above the general pop. and is tracking very closely to the Army.

Clearly a conclusion that combat action (or its possibility) raises suicide. The report does make that one of its conclusions in this section, but both recommended actions deal with self-selection bias of recruits towards high risk behavior - again, note it does not mention suicide specifically.

All for now, BTW, why does the comment system use the Azores and Cape Verde time zone?

we need to get past the rhetoric....this is NOT a "rhetoric" problem....this is a "human" problem....and it is complex.:....so.....

1. " increase health care access"....what does
that mean to a squad leader, plt sgt, plt ldr, co cdr, 1SGT?....what is the behavior that is associated with that solution?!.....obviously these leaders can't build, create, or hire "health care access".....so that means they need to be able to identify that

a) a Soldier needs help and b) ensure the Soldier gets the help......OK, what do these 2 mean in terms of behavior?..... are our 1st and 2nd line leaders e able to identify that a Soldier needs help?.....this requrires some close personal knowledge of the subordinate, his/her needs, strengths, weaknesses, experiences, habits, family situation, likes, dislikes, etc etc etc..being able to know and do this requrires empathetic leadership...."being able to put yourself in the shoes of the subordinate".....this is difficult to do but can be done....and can be taught.....

being able to do this is different that being able to lead a patrol, fire a weapon, call for fire, provide first aid, communicate, etc etc....I call this "leadership 101" or "know your Soldiers"....if a leader REALLY knows his'/her Soldiers, they will know they need help....(oh yes...this takes TIME....this is called "LEADER TIME")

b) to ensure they get the help they need, are all levels in the chain of command going to allow PVT/SPC/SGT/LT Doe to get the "in patient" (this means TIME) help they need?....this means that Doe will miss lots of "mandatory" training....will the chain of command allow that??!?!?....I argue this is completely counter culture in our military today.....

2. "reduce the stigma associated with help seeking behavior"......this statement speaks to the behavior associated with it.....so we need to have leaders (squad ldrs, plts sgts, plt ldrs, 1SGTs, Co Cdrs, etc) consistently and repetitively talking about and REWARDING (behavior modification) leaders who are "reducing the stigma"...for example, "SGT Smith, that is great that you have identified that SPC Jones is having some real problems dealing with the death of his battle buddy.....Jones is drinking way to much on weekends.....I know that you will be taking SPC Jones to his mental health appointments next week......those appts are during our live fire training, but it is OK if you miss them....we will have SPC Wilkens act in your position"

3. "implement the Army's Pain Management Plan"....the behaviors associated with this relate back to my points #1 and #2 above....

bottom line...leadership is leadership...leadership is a human to human endeavor and takes LOTS OF LEADER TIME...and Soldier problems are comples and are leadership problems with real behavioral solutions....not rhetoric...

I haven't read this study yet though I do have it downloaded and at the ready.

Having said all that after skimming some key points in the document and reading these exceprts in these postings...allow me to say. This is all shite.

Likely hundreds of thousands of dollars to produce this document to no effect. Disappointing at best.

Here's what the Army is missing. All of their work is about putting the Genie back into the bottle. It won't work. Suicide Prevention, Battlemind training, Chaplain counseling won't do anything to better prepare the soldier BEFORE combat. These guys need proactive traiing focused on physiology, stress inoculation, mental training, and moral/ethical training (see my posts in What every American Needs to Know for more - I won't redo it here).

I have just reviewed the Master Resiliency Trainer documentation from the school house. I looked at the NCO Guide and the whole training package available at:

Guess what, almost nothing proactive in that material. Almost NONE, ZERO, ZIP. The only thing that was truly useful was the "mindful breathing" aspect - which gets back to mental training. But there isn't enough there to be called a viable training plan.

Everything in the NCO Guide is targetted on what to do when a soldier presents problems (e.g. suicidal ideation, drug use, etc.). Dumb, this is all what I call "right of boom." In IED parlance after the bomb explodes all you can do is pick up the pieces. You want to get "left of boom" to target the problem ahead of time, and make sure the bomb doesn't go off.

This is all amusing, in the context of the study posted here, esp when they cite that these soldiers all demonstrated high risk behaviors...um, is this chicken and the egg logic we have here? Of course they demonstrate those behaviors - they are trying to self-treat a problem they never should have had - if they had been properly prepared (Disclaimer: some will always have this problem but without training and prep more will than need to have been).

All so infuriating. I am not a psychologist, but I have studied leadership and management for the last 10 years intensively, and I have been in the Army (or some form of it) for the last 22 years. I think they need to stop going to the psychs for all this information and talk to some no-shit combat veterans to get the real whatfor.

NONE OF THESE PROBLEMS WILL GO AWAY UNTIL WE START TARGETING THIS PROBLEM PROACTIVELY. PROACTIVELY, AHEAD OF TIME, LEFT OF BOOM, WITH SOMETHING OTHER THAN STUPID .PPT BRIEFS (which I think is the subject of another TR post).

"While military entrance standards help to ensure a healthy force (and likely explains the lower suicide rate in prior years), the recent prolonged conflict may be creating undue stress on the existing force as well as unintentionally shifting the Army demographic towards a larger risk-seeking population." p. 17

From what I've read so far, this is the study in an unintended microcosm. First, parenthetical and unsupported statement dealing directly with the issue of higher suicide rates. Then admission of lower standards causing problems, but labeling the issue "risk-seeking", which is double-speak for criminal activity and drug and alcohol abuse. These last issues, and not suicide, provide easier solutions (more disciplinary actions) and improve what matters most (readiness and number of forces available). I can't expect much else at this point. We'll see.

Interesting - table 3 on page 19. Active Duty Suicide Characteristics. In 108 cases in 2009, a death investigation produced details on the life of the soldier who killed himself. Stressors (can have more than one), alcohol or drug involvement (doesn't say if both can be listed) and primary motivation.

Stressors: Relationship 56%, Military / Work 57%, Physical Health 23%, Substance Abuse 17%
Involvement: Alcohol 18%, Drug 6% - I would guess this means at the time
Primary Motivation: Unknown 47%, Emotional Relief 17%, Hopelessness / Depression 11%, Avoidance / Escape 5%

Stressors and Involvement directly contradicts what the report has said so far. Primary Motivation is useless, but interesting to see their categories. Being the military, there must have been some criteria for each, I'd like to see that just for the insight into how the military looks at suicide. My feeling is that all suicides are "all of the above".

The Recommended Action is "Fund suicide behavior surveys that span both civilian and military populations in order to make direct comparisons." BS

I just remembered the common public service billboard - "#1 cause of suicide: untreated depression". Key words: cause and untreated. In all the focus of stressors and risk-factors, it is easy to forget that suicidal thoughts can be prevented from becoming suicides. Treatments from in-patient confinement to talk therapy to medication are very often successful prevention measures.

The stigma section predictably says it is a problem for soldiers. 51% of both officers and enlisted believe that seeking behavioral health counseling would negatively affect their careers. While they say they're working on it, the paragraph ends: "Until the stigma associated with behavioral health treatment can be overcome, the Army should continue to look at alternative methods for identifying Soldiers who may be in need of such care, either by command intervention or through medical encounters. The first step toward care, however, begins with Soldiers who recognize when they need help."

Keep looking, but don't fall for the blame the victim mentality. This is such a huge issue, and not just being sensitive, because in many, if not most, cases of suicide ideation and worse, the person is incapable of self-help. It is not a question of will or of simply wanting help. All of these people want help. Attempting suicide can be a cry for help. But that type of cry is very dangerous, especially when guns are involved. The solution to the problem is to identify potential suicides before they attempt it and then treat it.

The DoD Suicide Event Report is a "surveillance tool used to gather risk and protective factor information on suicides, suicide attempts, self-harm events and suicidal ideations. The overall goal of this report is to leverage lessons learned to better identify individuals at- risk."

The summary bullet points of the data is impressive. This is exactly what would make studying military suicide so important. There are some stats in the report from completed suicides, but the other three categories are not included. The "detailed discussion" promised in this section explains why with a listing of the problems of DoDSER regarding non-fatal suicide behavior. In summary, "The cumulative effect of these flaws means that reports are seldom timely, accurate or actionable." Sounds like terrorism "intelligence."

This is a real tragedy. There are plenty of recommendations to improve the report and the system that uses it. Those changes cannot come soon enough.

Page 24 lists the known stressors from previous chart, Relationship Problems and Work Stress, but the next two are not. Behavioral Health diagnosis is present in 48% and Legal Issues in 34% of suicides. These two new categories are true catch-alls, with BH diagnoses being Adjustment Disorder (haven't heard of that), substance abuse, PTSD and history of self-harm. Legal issues were even more varied, with Article 15 at 15% and civil legal actions at 13%, single digit percentages for pending proceeding and boards and Court-Martials.

However, the biggest two factors relationships and work are said to be catch-alls, hiding underlying problems. "Research into the root causes of relationship failures may help to more accurately define specific risk factors associated with suicidal behavior. A clear delineation of risk factors is critical in developing specific training and education targeted to reduce suicidal behavior." pp 24-25.

This is the wrong focus. The key point here is almost 3 in 5 suicides involved the soldier's relationship. There should be tremendous outreach to wives and girlfriends of soldiers to make them aware of the problem and give them resources to use if they think their husband or boyfriend needs help. They are the most invested in the soldiers and least conflicted about getting them help.

"Work-related stress may include voluntary or involuntary separation from the Army, dangerous work environment (combat), or the increased OPTEMPO of an Army at war. This stress factor as an indicator for suicide has been steadily increasing over the past five years from 32% in 2005 to 57% in 2009."

Obviously the last sentence is huge. At this point, I would peg increased suicides to lower recruiting standards and increased deployments. All the PR hype about high-risk behavior is BS.

I just realized that the two major stats cited - 79% of suicides has zero or one deployment and 60% of suicides were in their first enlistment - are meaningless unless you can compare them to the % in the whole Army with zero or one deployment and in their first enlistment. If anybody's still reading this, can they find those numbers?

The Chiarelli quote about speculating that two or more deployment suicides are rising is still really bugging me. You mean you took 15 months to write this report and you end up with a hunch?

the "data" is there for those that want to analyze it to death....but like any data, it is only as good as "do we really want to do anything with it?"....or,"don't ask the question if you don't want the answer"......

break break....as has already been mentioned...leadership is leadership....it is a human endeavor....Leaders in the military have a DUTY to "know" their Soldiers, Marines, etc.....it really is that simple....

not ALL of the sucides and other issues can or will be solved if leaders know their Soldiers...but the problem would NOT be as bad as it is now....

all good points....I don't think "leaders" is a meaningless term....I guess it could be if one does not know what it means...however, if it really is a meaningless term, than our military should stop using it....they/we should not use words that have no meaning...

I agree that we should not blame others....personal responsibility is a big deal, and so is collective responsibility.....they go hand in hand on real teams/units......but if leaders (sorry, but I think I know what it means) really understood and internalized ALL of their responsiblities as leaders (sorry again), this problem would not be where it is today....one of those responsibilities is the duty to know their people....I call that duty "leadership 101".....

Well,
Fairly easily, actually. Several years ago, a Staff Sergeant in my unit apparently drove off a cliff in the mountains north of Camp Pendleton. No one knew where he went or why he was missing. He had an argument with his wife, walked out, and no one saw him again. He was found, still in his truck, by hikers weeks later at the bottom of a ravine. There were no skid marks and the investigators suspected suicide.
As his unit's leader I knew he was married to a successful veterinarian and I had met her at least twice. We had talked about their relationship a couple times, the usual kind of passing remarks about marriage, griping about women etc.. Didn't sound like a perfect marriage, but basically the normal relationship crap everyone goes through. Truthfully, I never thought to bring up the subject in conversation, you know, oh, hey, I hope things go better with your wife and by the way, don't commit suicide. No one expected it, and no one saw it coming.
I don't know what the other circumstances of these situations were, but it might not be as preventable as it sounds.

I'm going to quote a lot because this thread is so old:

"Vignette 5 - Relevant Stressors in Field Grade Officer Suicides: A Lieutenant Colonel was apprehended by CID for bribery and solicitation related to contract fraud. On two separate occasions during ten days of pre-trial confinement, he was found possessing weapons (i.e., razor blade and nail) and told guards he intended to harm himself. Despite this information being presented to the appropriate authorities, the Lieutenant Colonel was released from confinement. He committed suicide approximately ten days later by ingesting poison.

From 2006-2009, criminal legal issues were the most prevalent individual risk factor for senior personnel and contributed to 39% (7 of 18) of field grade officer suicides. Marital difficulties were the next prevalent risk factor and contributed to 28% (5 of 18) of these suicides."

Next sentence in report: "Early recognition of any or all of these risk factors represents an opportunity for leaders, law enforcement personnel, medical and other program/service providers to intervene in this high risk behavior and either rehabilitate through treatment or separate as appropriate." Another sentence about medical issues and the section is over.

The conclusion and recommended action for this situation is: "Early recognition and intervention of legal, medical and disciplinary risk factors presents an opportunity for leaders, law enforcement personnel and program/service providers to prevent negative outcomes." and " Identify and mitigate stress during the critical window of legal/law enforcement encounters and subsequent adjudication actions."

Atrocious! How can you say anything about this vignette other than the appropriate authorities are culpable in the officer's death? "he was found possessing weapons (i.e., razor blade and nail) and told guards he intended to harm himself"!!! The only question is to whether he should be committed to a psychiatric ward or allowed to receive frequent out-patient services with close monitoring at all times. This person's life is in danger. Would you allow a soldier to get into a firefight without a helmet and body armor if you had that choice?

"Risk factors" are the "body count" of this report. Damn all metrics! When you have someone who you think is at risk DO SOMETHING ABOUT THE PERSON! And "mitigate stress" doesn't cut it. What does that mean anyway? Give massages in the brig? Soothing music at court martials?

I'm sure I've said this above, but people do illegal things and have bad relationships. Always have, always will. But not all people in these situations kill themselves. Identifying who is statistically at risk is a fool's errand. The situation that is possible to control is what happens when a specific behavioral health issue arises. Save that soldiers life. Do not allow another suicidal patient to go without treatment.

And the terrible "separate as appropriate" suggestion. This report isn't about preventing suicides. It's about risk reduction - for the Army.

Page 26, c. Medical Issues, first paragraph: "Receiving a serious behavioral health diagnosis is a life changing event for any Soldier. For some, the reluctance to continue care, perceptions of stigma for seeking treatment and a long term prognosis combine to create real stress that contributes to suicidal behavior."

"Real" stress?!? Having a serious behavioral health issue isn't "real" enough? And doesn't that contribute more to suicidal behavior than this "real" stress? This report is an embarrassment.

Two paragraphs on Post Traumatic Stress (PTS) and PTS Disorder (PTSD), one of which is just statistics. I've lost the ability to be outraged after reading this: "PTSD diagnoses have been steadily increasing in the Army over the past seven years. For these reasons, the Army’s objective is to prevent PTS from becoming PTSD." How is the Army going to do that? It should be learning how to treat PTSD.

Medication Implications. Utterly useless. 4 paragraphs. The first lumps narcotic pain management in with antidepressants and other psychiatric drugs. The second cites the national crisis of overdoses (particularly from opiates). The third is about the danger of young people taking SSRIs and Paxil together (so don't do it!). The fourth is about pain management. Can't resist quoting this inanity:

"MEDCOM has recently developed a comprehensive pain management strategy that is a holistic, multidisciplinary and multimodal approach to optimize quality of life for patients with acute and chronic pain. The comprehensive pain management strategy has over 100 recommended changes to programs and policies that will be implemented by MEDCOM to standardize pain management Army-wide." Over 100 changes that are holistic and multimodal? Standardized pain management? Geepers, that's good!

Page 29, Co-morbid Complications. "A history of behavioral health diagnosis is strongly associated with increased incidence of high risk and suicidal behaviors. As depicted in Figure 11, the CHPPM estimates the suicide rate is markedly higher for Soldiers diagnosed with behavioral health disorders and PTSD than it is for Soldiers who have no history of a behavioral health diagnosis." Well, at least we know the the Army isn't over-diagnosing BH disorders.

"Post-deployment health concerns likely involve a complex interaction of war-zone traumatic events, war-zone injuries (including mTBI/concussion), sleep deprivation, physiological manifestations of extreme physical stress (including PTSD), medications, substance abuse, etc."

Etc. ?!? Too many negative consequences to list, eh? I guess someone's fingers got tired. Seriously, can anyone read that and avoid concluding that we shouldn't be creating war-zones? No? How about this:

"Diagnosed cases of PTSD have steadily increased in the Army since 2003. Untreated PTSD can lead to suicidal behavior." Yet not a word about increasing or improving treatment of PTSD.

Recommended action verbs for this section:
Implement standardized treatment protocols
Enhance policies
Conduct comprehensive research and analysis
Conduct research

The last one is particularly egregious: "Conduct research to identify appropriate antidepressant medications that are beneficial to the treatment of depression and anxiety, but that will not increase risk for suicidal behavior." No more research is needed. Appropriate medications have been treating depression and anxiety for decades. One combination of specific drugs in young people may be bad. Fine. Prescribe any of the other effective and safe drugs by themselves or in the hundreds of combinations that are deemed safe and effective as well. The writers and reviewers of this statement know virtually nothing about psychiatry. Is there anything worse I can say about this report?

Missed another rec on the next page: "Initiate research to develop effective mitigation strategies to counter the effects of comorbidity on Soldiers and address the full spectrum of war-related health concerns."

How about developing mitigation strategies to avoid wars?