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DOD, Services Work to Prevent Suicides

WASHINGTON, Sept. 9, 2011 -- Officials know the facts about suicide in the military services, but the causes and best means of prevention are more elusive, a senior Defense Department official said today.

In testimony before the House Armed Services committee, Dr. Jonathan Woodson, the assistant secretary of defense for health affairs and director of the TRICARE Management Activity, said DOD has invested "tremendous resources" to better understand how to identify those at risk of suicide, treat at-risk people, and prevent suicide.

"We continue to seek the best minds from both within our ranks, from academia, other federal health partners, and the private sector to further our understanding of this complex set of issues," Woodson said.

The overall rate of suicide among service members has risen steadily for a decade, he said, and DOD and the services are taking a multidisciplinary approach in their efforts to save lives.

The Defense and Veterans Affairs Departments are developing shared clinical practice guidelines that health care providers in both agencies will use to assess suicide risk and help prevent suicide attempts, Woodson said.

DOD also is working with the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration to offer critical mental health services to National Guard and Reserve members, who often don't live close to military medical facilities, he added.

Woodson acknowledged much work remains.

"We have identified risk factors for suicide, and factors that appear to protect an individual from suicide," he said. "As you well understand, the interplay of these factors is very complex. Our efforts are focused on addressing solutions in a comprehensive and holistic manner."

Defense suicide prevention research includes Army 'STARS,' a study to assess risk and resilience in service members, Woodson said.

"This is the largest single epidemiologic research effort ever undertaken by the Army, and is designed to examine mental health, psychological resilience, suicide risk, suicide-related behaviors and suicide deaths," the assistant secretary said.

The study, he said, involves experts from the Uniform Services University of the Health Sciences, University of California, University of Michigan, Harvard University, and the National Institute of Mental Health.

STARS is examining past data on about 90,000 active-duty soldiers, evaluating soldiers' characteristics and experiences as they relate to subsequent psychological health issues, suicidal behavior and other relevant outcomes, he said.

DOD has added more than 200 mental health professionals from the Public Health Service to medical facilities' staffs, and is expanding access to services in civilian communities, Woodson said.

"Within the department, we have amended medical doctrine and embedded our mental health professionals far forward ... to provide care in theaters of operation," he added.

The department also has worked to collect, analyze and share data more effectively "so that the entire care team understands the diagnosis and treatment plan," he said.

"As important as any step, we have also made great attempts to remove stigma from seeking mental health services, a stigma that is common throughout society, and not just in the military," Woodson continued. "This is a long-term effort, but both senior officers and enlisted leaders are speaking out with a common message."

Defense leaders are encouraged that service members increasingly now seek professional help when it is recommended, he said.

The service chiefs of staff for personnel also testified at today's hearing:
Army Maj. Gen. Thomas Bostick, Navy Rear Adm. Anthony Kurta, Marine Corps Lt. Gen. Robert Milstead Jr., and Air Force Lt. Gen. Darrell Jones.

The strain of decade-long war is wearing on soldiers and their families, Bostick said.

"The most-tragic indicator of this stress is the historically high number of suicides that we have experienced in recent years," he said.

The past year has seen a slight decrease in suicide incidence among active-duty soldiers, which officials credit to programs and policy changes that began in March 2009, Bostick said.

Army research shows those programs help mitigate stress for active-duty troops, but reserve component soldiers don't have access to the same support networks or the oversight of as full-time chain of command, he said.
"This is a complex problem; it has no simple solution," Bostick said.

DOD and Army leaders are working "to better understand the problem, and then to get the leadership involved at every level in what we learn from those conversations, what we learn from our monthly reviews of these suicides," he said.

Navy suicide rates declined from 2009 to 2010, but the current rate shows an increase over last year, Kurta said.
The Navy's suicide prevention programs combine stress control, psychological health outreach to Reserve sailors, health promotion and family readiness, Kurta said.

"We view suicide prevention as an all-hands-on, all-of-the-time effort," he said. "It involves sailors, family members, peers, and leadership."

Kurta cited the Navy's Coalition Of Sailors Against Destructive Decisions, a peer-to-peer mentoring program that "empowers our most-junior sailors to make responsible decisions and to reach out to their shipmates in need."
The program now includes 200 chapters across the Navy, he added.

Milstead said the Marines saw a nearly 30-percent decrease in suicides during 2010, from 52 to 37, and numbers so far this year are still lower.
Marine Corps officials hope the downward trend continues, but will continue to aggressively improve suicide prevention programs at all levels and focused on encouraging service members to seek help early, he said.

"As Marines, we pride ourselves on taking care of our own," Milstead said. "A Marine struggling emotionally is a wounded comrade, and we don't leave our wounded on the battlefield."

He said the Marines found that the "leader-to-led ratio" before, and more critically after, a deployment could affect suicide attempts.

"We quickly discovered that it was on the backside of that deployment where it was even more important, as we've come to call 'the dark side,' for at least 90 days when a young Marine returns from a deployment and [has] to dance with some dragons of things that he's seen," Milstead said.

Jones said the Air Force total strength includes 693,000 uniformed and civilian members. This year, 56 of them -- officer, enlisted and civilian -- have taken their own lives, he said.

"Although that number of suicides is lower than the same period last year, it is still a major area of concern for our force, as it sends ripples across the family, the unit and the community," he said.

Air Force officials have "redoubled" post-suicide care at the unit level and enlisted the aid of health care professionals to develop a comprehensive guide to help leaders respond to suicides within their ranks, Jones said.

"We are keenly aware that a proactive response by unit leadership plays a role in prevention of additional suicides and attempts," he said.

The Air Force recently developed the Comprehensive Airmen Fitness program, focused on bolstering physical, mental, spiritual and social fitness, Jones said.

"We know that as society changes, so do our airmen, and it is important that our strategies for being resilient airmen continue to be as resilient and as flexible as our force," he added.

Woodson said while DOD and the services have a number of suicide prevention programs in place, it's critical to develop measures showing which programs are most effective.

"One of the things we have to really be careful [about] in a resource-constrained environment is that we don't fund programs that are not effective, and [also don't] allow others that would be effective to wither on the vine," he said.

Some approaches have been proven effective, Woodson said. Service members in custody following legal difficulty are at higher suicide risk, so evaluating that risk is important. Also, peer-to-peer programs seem to work, as does access to high-quality mental health care by professionals experienced in evaluating and treating suicide risk, he said.

DOD's strategy is to place mental health specialists adept in screening for suicide risk within military units, and ensure "high-end specialists" can then follow up to treat more complex problems, Woodson said.

"It's not only a question of numbers; it's a question of the right distribution of specialists to make sure we get the job done," he said.