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In suicides, Army faces steepest challenge

Sep. 25, 2012 - 12:03PM   |   Last Updated: Sep. 25, 2012 - 12:03PM  |  
The Army's suicide intervention card is designed to be a quick reference for helping, or getting, help.
The Army's suicide intervention card is designed to be a quick reference for helping, or getting, help. ()
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HOW TO GET HELP

It’s important for soldiers and their families to know that help is available, said Bruce Shahbaz, special assistant to the director of health promotion, risk reduction and suicide prevention.
"Help is available, help is effective, and individuals should seek help if they’re in distress," Shahbaz said. "It’s important for us to take care of our soldiers."
Resources include:
The National Suicide Prevention Lifeline: 800-273-8255
Military OneSource
Military Crisis Line
The Army Suicide Prevention Program
• Wounded Soldier and Family Hotline: 800-984-8523 or 421-3700 (DSN in the U.S.) or 312-421-3700 (DSN overseas)

Facing an enemy it can't seem to defeat, the Army continues to lose more soldiers to suicide than to combat in Afghanistan.

So far this year, the Army has reported 212 suspected suicides — 132 active-duty soldiers and 80 National Guard or Army Reserve soldiers who were not on active duty when they died.

During the same time period, January through August, the Army lost 171 soldiers in Afghanistan. In FY2011 there were more than 1,000 known suicide attempts.

Army leaders don't know why the service is seeing a spike in 2012, Chief of Staff Gen. Ray Odierno told Army Times.

The Army reported 28 active-duty soldier suicides in July, a record high monthly total.

"Why has it spiked this year? Is it because we're coming down off the number of deployments? Does it have to do with soldiers who had existing problems, problems that weren't taken care of? We don't know," he said. "It's something that we keep trying to figure out, but we don't know the answer yet."

In the Army's ongoing battle against suicide, some troubling trends have emerged:

• More soldiers are dying by suicide than in combat.

• The service is on track to reach its highest suicide rate yet — 29 suicides per 100,000 soldiers per year, more than three times the rate in 2004 and a more than a 25 percent increase from last year.

• More noncommissioned officers and soldiers with multiple deployments are committing suicide.

• Some soldiers are falling through the cracks. A Defense Department study showed 45 percent of service members who died by suicide were seen by military health care professionals in the 30 days before their deaths.

• Despite efforts by the Army, soldiers still worry about the stigma attached to seeking help.

• 75 percent of those who attempted suicide were seen somewhere in the outpatient health care system within 30 days before their suicide attempt.

Sgt. Cindy Davignon, who is assigned to Ireland Army Community Hospital at Fort Knox, Ky., has lost four friends to suicide. Two of them, she said, appeared to be doing well.

"Nobody saw it coming," she said. "They appeared normal on the outside, but who knows what was going on on the inside. I've lost too many friends to this."

"Suicide is the toughest enemy I have faced in my 37 years in the Army," Vice Chief of Staff Gen. Lloyd Austin III said when he ordered a servicewide standdown Sept. 27 to focus on suicide prevention.

At-risk NCOs

The statistics are daunting.

Last year, the Army's suicide rate was 23.1 per 100,000 soldiers per year, said Bruce Shahbaz, special assistant to the director of health promotion, risk reduction and suicide prevention.

Based upon the first eight months of the year, he projects the 2012 rate to spike to 29 per 100,000 soldiers per year.

"God willing it's not that way, but that's what we're looking at right now," he said.

That rate is a massive jump from 2004, when the Army's suicide rate was 9.6 per 100,000 soldiers per year, Shahbaz said. Or even from 2008, when the rate was 19.6 per 100,000 soldiers per year, nearly the same as the national rate for that period.

The Army continues to struggle with reasons for and solutions to the high suicide numbers, Shahbaz said.

"We're recognizing that there are a lot of additional stressors on soldiers that we're starting to understand a little bit better now," he said.

For the past few years, most of the soldiers who committed suicide had never deployed or had just one deployment, and they were believed to be the most at-risk population, Shahbaz said.

In 2010, 75 percent of suicides were by soldiers who had not deployed or had one deployment, he said.

"We're now seeing that population makes up 63 percent [of deaths] and we've seen almost a doubling in the percentage of soldiers with two and three deployments who had died by suicide."

This year, the Army has lost more NCOs to suicide (45 percent of the deaths) than it has junior enlisted soldiers (42 percent), Shahbaz said.

One theory behind the shift is that leaders have focused their attention on the junior enlisted because they were the most at risk, Shahbaz said. One of the goals of the standdown is to make sure leaders know who is at risk, he said.

"Another possibility is that we see difficulty with reintegration following deployments as dwell starts to increase," he said. "If you're on that 12-month treadmill of prepare, deploy, reset, prepare, deploy, reset, soldiers aren't really trying to reintegrate with their communities and their families because they're not there long enough."

But as operations in Iraq wrapped up and the drawdown in Afghanistan continues, "their dwell time is starting to increase, [and] these problems are starting to surface, so now the stress associated with that reintegration is starting to manifest itself," he said.

The poor economy also could be a factor, Shahbaz said, and some soldiers who may want to leave the Army because they're worn out from repeat deployments may not do so.

"That's why [senior Army leaders] have put a lot of emphasis on transition issues," Shahbaz said. "We're in the middle of all this right now so these are all just theories."

Developing acceptance

Suicide prevention is a leadership issue, and Army leaders at all levels must take charge, Odierno said.

"Our business is about knowing our soldiers, understanding their issues, making sure that we have the right policies in place, that we have the right leadership techniques in place, in order to ensure we're safeguarding our soldiers," he said. "They are our most valuable asset. When we lose one, no matter that it's to suicide or to combat, it's a great loss, and it's important to us to react to this."

Commanders must foster a climate that ensures soldiers are comfortable asking for help or reaching out to help their battle buddies, Odierno said.

"It's important that the chain of command develops a culture and an environment that this is acceptable," he told Army Times. "It's about inculcating this throughout the force."

Leaders who aren't concerned about suicide prevention are a cause for concern, Odierno said.

"I think every leader should be involved in taking care of this problem," he said. "If there's somebody who believes this is not a big problem, [that] we don't need to be concerned about this, we need to take a hard look at whether this person should be in command or not."

LOL isn't leadership

Suicide prevention also is a soldier issue, Odierno said.

"We need our soldiers to intervene," he said. "They're the ones who might be the first ones to recognize a change in behavior in somebody. We need them to intervene."

Lt. Col. Michael Baumeister, deputy commander of the 82nd Sustainment Brigade, said engaging leaders — those who care enough to get to know their soldiers — make all the difference, and face time is the key.

"The focus needs to be where the leader-to-led ratio is the best, at the squad or platoon level," Baumeister said. "Don't have the mass formation where 100 people get the PowerPoint. Put 10 people in a room where you're looking people in the face, eye to eye and engaging."

Young leaders may too often rely on email and text messages to communicate, losing opportunities for in-person contact, he said.

"I think young leaders text people the requirements for the next day, but LOL — laughing out loud — isn't leadership," Baumeister said. "As we develop our noncommissioned officer and officer communication, it's important that we put in that face-to-face contact piece."

Baumeister said he eats in the dining facility so he can meet NCOs and ask such questions as, "How many people are you responsible for?" and "How's your unit doing?"

Brigade leadership pays close attention to the numbers of "significant activities," including suicidal ideations and domestic violence among other categories, he said.

Recently, when a female soldier failed to show up for morning physical training, he said, her squad leader went to her house immediately afterward; she found her overdosed on sleeping pills. Because she cared enough to go to the soldier's home, the NCO got the soldier to the hospital in time to save her life.

"I can tell you that when we [investigate] these things, somebody should have seen these things [earlier]," Baumeister said. "The Army has this correct; the emphasis on reporting is making a positive difference ... I think our young sergeants are comfortable enough to get people to the hospital where they can get help."

Starting in the barracks

One upcoming change that will help with suicide prevention is a push to get officers and NCOs once again responsible for the barracks, Odierno said.

"For a long time, we went away from that," he said. "We went to centralized management of the barracks ... [like] you would do it if it were a dormitory in college. [Now] I want to have command presence in the barracks. I want noncommissioned officers and officers who are back talking to soldiers, who are in the barracks on a regular basis … so it gives them an opportunity to have more contact while they're off duty."

Col. Sam Whitehurst, commander of the 3rd Brigade Combat Team, 10th Mountain Division, at Fort Drum, N.Y., said there is an expectation that the brigade's NCOs know their soldiers and dig for information.

"When you start picking up on things, whether it's financial difficulties or relationship difficulties, just start to ask questions and based on that, get them the appropriate care," Whitehurst told Army Times.

Whitehurst said that at Fort Drum, there's an emphasis on having leaders up and down the chain of command circulate in the barracks. As it happens, there's a surprising amount to be learned on the weekends, particularly at 2 a.m. on a Saturday.

"That's when you'll see soldiers who are maybe having too much of a good time," he said. "You may have soldiers returning to the barracks with too much to drink or drinking too much in the barracks. That's the kind of thing you're looking for."

Over the years, he said, there has been a misperception that NCOs cannot visit soldiers' rooms, but it isn't so. He even encourages NCOs to stop by their soldiers' homes off post — with a courtesy call first.

"It's basic leadership that you have to know your soldiers, and know their families," Whitehurst said. "You've got to know what that soldier does on the weekends. This is not a 9-to-5 job."

Combating stigma

Otherwise, the brigade's aim is to erase the stigma attached to asking for help. Whitehurst touted brigade statistics that show more than 250 personnel in the unit have visited behavioral health professionals since June.

To emphasize how it's all right to seek help, he encourages leaders to share personal stories. He talks about his own dark memories of when 10 soldiers in his unit died in a helicopter crash in Iraq in 2007, when he was their battalion commander.

"That experience, that was a tough day," he said. "Sometimes I'm taken back to the events of that particular day, and my way to cope with it is, if I can, I give my wife a call. She's used to that phone call because she's had it with me several times. She talks me through it, and I'm fine."

Whitehurst said such feelings are part of what it means to be a soldier; soldiers should accept that and have a plan to deal with it.

"It's OK to have those feelings and to ask for help, especially for the soldiers who have been deployed," Whitehurst said. "They've seen some tough things, and it's OK."

The Army's senior enlisted soldier also has tried to drive home the message that it's OK to seek help.

During a visit to Fort Rucker, Ala., in August, Sergeant Major of the Army Raymond Chandler shared with soldiers a near-death experience he had while deployed, according to Army news reports on the visit.

Chandler talked about seeking individual and family counseling.

"If I can be sergeant major of the Army and be in health care counseling, you can be in whatever it is that you do and get help and get counseling, and there is nothing wrong with that," he said.

Chandler added that seeking help is a mark of courage.

"I had some help and it was good, and it has really made a huge difference in my life," he said. "I'm a better man, I'm a better husband, I'm a better father, and last but not least, I'm a better soldier because of my counseling."

Davignon, the sergeant who has lost friends to suicide, has seen some improvements.

"When I first joined the Army to now, they have tried to wipe that stigma away," she said. "Back in the day, it wasn't OK if somebody needed behavioral health. Now they try to make it pretty accessible."

The Army continues to recruit more behavioral health specialists, but it will take time to find the right people.

"We've made some progress, but we're still competing with many, many different entities," Odierno said.

Hindsight

In fact, many of the soldiers who died from suicide sought help.

A Defense Department study found that 45 percent of service members who died by suicide and 75 percent of those who attempted suicide were seen somewhere in the outpatient health care system within 30 days of their death or suicide attempt, Shahbaz said.

"We've got an opportunity with about half of the people who die, to intervene in some way," he said. "Some health care professional saw them in some way, and we had an opportunity and we missed that opportunity."

It's rare for a suicide to come out of the blue, Odierno said.

"That's why we go through an after-action review," he said. "There are very few cases, there's been a couple, where it's completely out of the blue. If we had just known this, or if we had just done this, we probably could have prevented this. It's about us getting better at recognizing that. It's about us understanding where those seams are. It's about educating our leaders on what to look for. It's about them also changing the culture where people can come forward. It's about not being afraid to intervene."

Measuring prevention is very difficult, Shahbaz said.

The Army has seen an increase in soldiers who have sought behavioral health services, he said.

In 2011, more than 280,400 were seen by a behavioral health specialist, nearly twice as many as in 2007, Shahbaz said.

"That's 135,477 more soldiers who were seen, screened, and if needed, treated," he said. "This is a significant increase in capacity and a significant reduction in the risk for those individuals who were seen. This shows the progress that's being made in stigma reduction, but we still have lots of work to do."

Odierno agreed. The Army must reinforce its policies on matters such as security clearances, promotions and leadership positions, so soldiers don't have to worry about their careers being affected if they seek help, he said.

"It's important for us that they feel comfortable to come forward," Odierno said. "I think we've made movement [on eliminating stigma] but I think we still have a long way to go. I'm hoping with all the effort we've put into this, within the next three, six, nine months, we're going to see a huge shift."

Staff writer jgould@militarytimes.com?subject=Question from ArmyTimes.com reader">Joe Gould and managing editor rsandza@militarytimes.com?subject=Question from ArmyTimes.com reader">Richard Sandza contributed to this report.

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