March 11, 2009 – The Department of the Army has finally gone public and acknowledged the alarming rate of suicide among its ranks. While Army leadership is to be commended for breaking the barrier of silence regarding mental illness in the military, the underlying culture of secrecy that has contributed to the current trend is in dire need of reform. According to figures obtained by the Associated Press, there has been a steady increase in suicides since 2003, totaling 450 active duty soldiers, with the highest numbers occurring in the past year. Military suicides vary considerably between branches of the service, with the Army and Marine Corps frequently reaching the highest annual rates. Longer and more frequent deployments and the primacy of ground combat operations are factors often blamed for the Army’s higher rates of physical injury, mental illness and suicide.
In October 2008, the Army announced a five-year, $50 million collaborative study with the National Institute of Mental Health to address suicide. In a rare public admission of the urgency of the problem, Dr. S. Ward Cassells, assistant secretary of defense for health affairs, stated in the New York Times, “We’ve reached a point where we do need some outside help.” Such efforts are encouraging but will yield little immediate assistance to active duty soldiers, returning veterans and their families.
The Army is now investigating 24 suspected suicides that occurred in January 2009, compared with five during the same month in 2008. “The trend and trajectory seen in January further heightens the seriousness and urgency that all of us have in preventing suicides,” said Peter Chiarelli, Army vice chief of staff, in an AP interview last month.
Republican Sen. John Cornyn, R-Texas, prevailed upon Secretary of the Army Pete Geren to agree in 2008 to investigate a suicide cluster of four recruiters since 2005, all within an East Texas battalion.
At the completion of Brig. Gen. Dell Turner’s investigation last month, he told the Houston Chronicle that there was no single issue leading up to the suicides. He said a combination of factors, including poor leadership, stress and individual issues led to the deaths. The investigation resulted in a rare one-day stand-down for all Army recruiters for suicide prevention training. It is only with this scope of commitment that the Army will fulfill its institutional responsibility to provide appropriate mental health care for its service members.
It is notable that the Army only began keeping records on suicides in 1980, a policy likely fueled by the cascade of attempted and successful suicides by Vietnam veterans. In 1983, with the introduction of the diagnosis of Post Traumatic Stress Disorder (PTSD) in the American Psychiatric Association’s Diagnostic & Statistical Manual, the military and VA began, finally, to acknowledge the debilitating effects of this combat-related trauma reaction. Increased risk of suicide is among the many symptoms of the half-million Vietnam veterans diagnosed with chronic PTSD. Using the most conservative estimates, there may be as many as 75,000 active duty military or recently discharged veterans with PTSD or significant symptoms of PTSD, according to psychologist Alan Peterson of the University of Texas. Peterson is a researcher with a multidisciplinary consortium recently awarded a $25 million Department of Defense grant to study behavioral treatments for PTSD.
To date, there has been no comprehensive epidemiological study on military suicides resulting from PTSD. In 1988, however, the Centers for Disease Control presented congressional testimony, confirming 9,000 suicides among Vietnam combat veterans.
In a March 2008 e-mail exchange brought to light by the Senate Veterans’ Affairs Committee and the VA Inspector General, Dr. Ira Katz, the VA’s chief of mental health services, referenced an internal report suggesting that a thousand Vietnam veterans were attempting suicide each month.
Katz and a VA colleague questioned disclosing the figures and discussed the agency’s financial disincentive to give the diagnosis of PTSD. Sadly, this stance is far from the model of transparency and collaboration among the VA, DOD and the military required to significantly stem the rising tide of mental health casualties.
One bright spot, however, warrants mention. In July, 2007, Army psychologist John Fortunato opened the doors of the Restoration and Resilience Center at Fort Bliss, Texas, an intensive, in-patient treatment program for active duty soldiers with PTSD. At the ribbon-cutting ceremony, Brig. Gen. James Gilman said, “It’s important to try new things because clearly what we’ve been doing so far isn’t working.” Above all, Fortunato believes that providing appropriate care to soldiers with combat-related PTSD is one more way for the Army to fulfill the soldier’s creed: “Never leave a fallen comrade.”
Greenberg is developing a curriculum for chaplains on the physical, psychological and social dimensions of combat-related PTSD.