Suicide prevention continues to elude Army leaders

While the Army has devoted unprecedented resources and attention to the increasing suicide rate of soldiers, service leaders still don't have a good handle on how to prevent troops from taking their own lives.

"It's deeply disconcerting," said Col. Elspeth Ritchie, a psychiatrist and the Army's director of behavioral health. "We've been working on this for a long time, yet still we had eight active-duty suicides in the first eight days of this year."

Ritchie made the remarks Monday during a conference on suicide prevention in Washington held jointly by the Defense and Veterans Affairs departments.

Army suicide rates have risen annually for the past several years. Army officials have not yet confirmed the number of suicide cases for 2009, but in December, the service reported 147 suicides through November, seven more than in 2008.

"We have been at war for a long time," Ritchie said. During that time, the Army has improved the data it collects on suicides as well as access to care, she said, noting that the service has increased the number of behavioral health care providers by 50 percent since 2007. Additionally, resilience programs now are widespread and a pilot program aimed at providing mental health services electronically to troops in remote locations is promising, but telemedicine is not a silver bullet, she said.

A major issue for the military services in coping with suicide remains the stigma attached to seeking mental health treatment.

"We cannot change stigma until we change the policies that contribute to stigma," Ritchie said. The services have varying policies, but access to weapons, deployment status and security clearances all can be tied to a member's mental health status and career-minded troops are reluctant to seek help if it will hurt them professionally. Also, younger troops are hesitant to seek help if it will put them in a bad light with their peers.

"In many ways we talk out of both sides of our mouth. We say, 'Come get treatment,' but if you get treatment and are started on medications you can't deploy, or … you don't meet accession standards. We have to change those policies, and we're working on it, but we're not there yet," she said. Part of the difficulty is balancing the health of the soldiers with a commander's need to know if a soldier is unstable.

While the Army has compiled strong clinical and epidemiological data on suicides, another major challenge has been developing an effective way to screen those at greatest risk, according to Ritchie. Most screening tools are designed for inpatient psychiatric populations and tend to focus heavily on mental disorders. Army data shows major psychiatric disorders are not a good indicator of suicide, she said.

The data point to a number of trends, including:

• Soldiers at highest risk tend to be in the infantry, military police and other professions with high rates of exposure to combat and easy access to weapons.
• Divorced soldiers are less apt to commit suicide. This could be because these soldiers already have reconciled themselves to frayed relationships, whereas soldiers in the throes of marital breakdown have not yet reached that stage of acceptance, Ritchie suggested.
• Suicide rates are increasing among all components of the Army, across all age groups and both genders.
• Treatment doesn't always help. "Our soldiers who are getting treatment are still committing suicide. In some cases, I fear it is making things worse," Ritchie said.

VA also is grappling with suicide as more veterans from the wars in Iraq and Afghanistan come under the department's care. Secretary of Veterans Affairs Eric Shinseki told conference attendees that on average 18 veterans commit suicide daily.

Also worrisome is preliminary data being analyzed by VA suggests that the suicide rate among 18- to 29-year-old men who have left military service rose 26 percent from 2005 to 2007.

Shinseki, a former Army chief of staff, said suicide is one of the most frustrating issues military leaders face: "Why do we know so much about suicides and still know so little about how to prevent them?"