Veterans for Common Sense

January 24, 2011 (New Haven Independent) – Troops who have deployed to war zones two or more times have a higher risk of committing suicide than those who have deployed once or never deployed, a new Army report shows.

The report—“Army 2020: Generating Health & Discipline in the Force”—shows the suicide rate among active-duty soldiers reaching a new high in 2011 of about 24.1 per 100,000—up from 9.6 per 100,000 in 2004. In terms of stressors, military work stress was the leading factor in suicides in 2010, replacing relationship problems, which had been considered the prime factor in suicides from 2003-09.

In the report, Army officials acknowledge that some of the suicides were preceded by warnings that went unheeded by leaders.

“To be sure, the Army has investigated numerous suicide cases that, in hindsight, seemed to present a clear trail of behavioral indicators that may have afforded leaders or others in the social circle an opportunity to respond,” the report said. “However, post‐mortem suicide investigations can never truly capture the subtlety of pre‐ suicide indictors, nor truly judge the appropriateness of the response within the pre‐suicide context.”

The Army has improved mental-health services and taken myriad other steps to stem suicides since 2005, as pressure on soldiers increased with long, repeated deployments. The new report shows that the percentage of suicides committed by soldiers who had deployed multiple times increased steadily from 2009 through 2011.

Army officials said that while the increase in suicides over the last six years has been “dramatic,” self-inflicted deaths among active-duty troops appear to be “stabilizing at approximately 160 deaths (per year)” in the last several years.

Among other findings in the report:

• Research indicates that Iraq and Afghanistan veterans in general are at higher risk for suicide immediately following the transition from active duty, with risk decreasing over time.  Following separation from active duty, veteran suicide rates were 23.1 per 100,000 in the first two years, 18.1 in years two through four, and 12.9 in years four through six.

• Approximately 950 veterans under VA care attempted suicide each month between October 2008 and December 2010.

• The Army reported an increase in sex crimes by active-duty troops—28 percent overall from 2006 to 2011. The increase was especially steep for violent sex crimes: from 665 in 2006, to 1,313 in 2011, (more than 90 percent).

• Domestic violence crimes increased 85 percent, to 2,699 incidents, from 2001 to 2011. Child abuse rose 44 percent, to 2,201 incidents, in the same period.

• Prescription drug use among soldiers has climbed, including psychotropic and controlled substances, which were used by 358,203 active-duty troops in fiscal year 2011—up from 337,932 service members in 2010. The report says, however, that research ” counters the assertion that the Army is overmedicating the Force ” compared to the civilian population.

• The Army provided outpatient behavioral health services to 280,413 soldiers in the 2011 fiscal year—up from 253,773 the year before. Incidence rates of mental-health diagnosis doubled from 2000 to 2009. Forty-four percent of soldiers who committed suicide in 2010 had received outpatient behavioral healthcare, with about 37 percent of suicide victims having been seen at a military treatment facility within 30 days of the event.

• Reported depression among soldiers can be attributed at least in part to deployments, with about one-third of soldiers reporting depression symptoms three to six months after returning home.  Research by the Institute of Medicine found that 27 percent of those who deployed three to four times received diagnoses of depression, anxiety or acute stress, compared to 12 percent of those who deployed just once.

The report cites several new programs designed to improve mental-health care, including pre- and post-deployment screenings and embedding behavioral health providers in combat units and in primary-care clinics. The Army pledged to continue seeking ways to improve soldier healthcare, including better detection and treatment of mental health issues and improvements to its transition services, to provide a “warm hand-off” of troops to VA healthcare programs.

“Leaders at all levels must recognize that while our Army has completed operations in Iraq and will eventually do the same in Afghanistan, this does not equate to less responsibility or fewer demands on them in coming days,” the report says. “To the contrary, arguably more will be asked of them during upcoming periods of reintegration and reset…The challenges facing our Army’s leaders in the days ahead are incredibly complex and consequential.”

Published January 18, 2012

| Associated Press

CAMP PENDLETON, Calif. –  When the Marine unit that suffered the greatest casualties in the 10-year Afghan war returned home last spring, they didn’t rush back to their everyday lives.

Instead, the Marine Corps put them into a kind of decompression chamber, keeping them at Camp Pendleton for 90 days with the hope that a slow re-entry into mundane daily life would ease their trauma.

The program was just one of many that the military created as it tries to address the emotional toll of war, a focus that is getting renewed attention as veterans struggling to adjust back home are accused of violent crimes, including murder.

While veterans are no more likely to commit such crimes than the general population, the latest cases have sparked a debate over whether they are isolated cases or a worrying reminder of what can happen when service members don’t get the help they need.

“This is a big focus of all the services, that we take care of our warriors who are returning because they have taken such good care of us,” Navy Secretary Ray Mabus said, pointing out that tens of thousands of veterans return home to lead productive lives.

Some, however, fall on hard times, getting into trouble with the law. Others quietly suffer, with their families and friends trying to pull them out of a depression.

In the latest high-profile criminal case involving an Iraq war veteran, a former Camp Pendleton Marine is accused of killing four homeless men in California. His family said he was never the same after his 2008 deployment. In Washington state, an Iraq War veteran described as struggling emotionally killed a Mount Rainier National Park ranger and later died trying to escape.

Suffering from combat stress is an age-old problem. What’s new is the kind of wars that troops fight now. They produce their own unique pressures, said psychologist Eric Zillmer, a Drexel University professor and co-editor of the book “Military Psychology: Clinical and Operational Applications.”

The war on terror “is very ambiguous, with no front lines, where you can’t tell who the enemy is. During the day, he may be a community leader and, at night, a guerrilla fighter. You never know when an assault takes place. It’s very complicated, and people feel always on edge,” he said.

Add to that, multiple deployments that tax the central nervous system, said Zillmer: “The human brain can only stay in danger mode for so long before it feels like it’s lost it. It gets exhausted.” He compared going into combat like “diving to the depths of the ocean and when you have to go back to the surface you have to decompress.

“It’s the same process,” he said. “It’s almost a biological process.”

A 2009 Army report concluded that the psychological trauma of fierce combat in Iraq might have helped drive soldiers from one brigade to kill as many as 11 people in Colorado and other states. The study found the soldiers also faced “significant disruptions in family-social support.”

The military’s stubbornly high suicide rate has proven that more help is needed, and that is why it has been investing in helping troops transition back from war zones.

Few units know war’s pain more than the 3rd Battalion, 5th Marine Regiment. The Camp Pendleton battalion nicknamed “The Dark Horse” lost 25 members in some of the heaviest fighting ever seen in Afghanistan. More than 150 Marines were wounded. More than a dozen lost limbs.

The Marine Corps brass, concerned about the traumatic deployment’s fallout, ordered the entire 950-member unit to remain on the Southern California base after it returned home. The 90 days was the same amount of time crews aboard war ships usually spend upon returning home.

During that time, the Marines participated in a memorial service for their fallen comrades. They held barbecues and banquets, where they talked about their time at war. Before the program, troops would go their separate ways with many finding they had no one to talk to about what they had just seen.

Mental health professionals are monitoring the group, which has since scattered. They say it is too early to tell what kind of impact keeping them together made. Combat veterans believe it likely will help in the long run. The Marines have ordered combat units since then to stick together for 90 days after leaving the battlefield.

“They share a commonality because they’ve gone through the same thing, so it helps them to come down,” said Maj. Gen. Ronald Bailey, the commanding general of one of Camp Pendleton’s most storied units, the 1st Marine Division.

“I can tell you from experience that this will help,” said Bailey, who served in Iraq and Afghanistan.

The new practice is one of a slew of initiatives ushered in by the new commandant, Gen. James Amos, who has made addressing mental health issues of Marines a top priority. He was concerned by the branch’s suicide rate, which has ranked among the highest of the armed services.

Commanders have tried to remove the stigma that seeking help is a sign of weakness. The Marines have set up hotlines and designated psychologists, chaplains and junior troops to identify troubled troops. “We’ve been in this 11 years and the medical staff and Marine officials are better educated now on dealing with combat stress,” Bailey said.

All service members also now undergo rigorous screening of their mental stability both before and after they go to battle.

While Veterans Affairs and Department of Justice have said veterans don’t commit more crimes per capita than others, the VA has launched efforts to help veterans in trouble with the law receive help rather than just be locked up.

Since 2009, the VA has had a legal team review cases to see if the best remedy is treatment instead of incarceration. States also have been establishing special veterans courts to do the same. Some say combat stress is also being used by criminals trying to get a lighter sentence.

Veterans agree the military has made great strides in the past few years but they say the help has come too late for many.

Paul Sullivan, executive director of the Washington, D.C.-based National Organization of Veterans’ Advocates, said the military only started administering medical exams of service members before and after deployments to Iraq and Afghanistan in 2007 to identify problems early so they can be treated more effectively and less expensively.

“It’s good their implementing it now, yes, however, what’s the military going to do with all of the veterans the military didn’t examine?” he asked. “That’s the problem.”

___

KATIE BAIRD Published: 01/18/12 12:05 am From Tacoma,WA News Tribune.com

As readers of this newspaper likely know, last year Joint Base Lewis-McChord suffered a record number of suicides (TNT 12-30). Tragically, this increase reflects a nationwide trend; suicide rates in the Army have doubled over the last 10 years.

Clearly all is not well with our armed forces. Divorce rates are climbing, and the unemployment rate among younger veterans now stands at 30 percent – twice the rate found among younger nonveterans.

In this column I’d like to draw attention to a slow shift occurring in civilian-military relations that contributes to the growing challenges faced by soldiers re-entering civilian life.

Recently the Pew Research Center published the results of its extensive surveys of veterans. It found that almost half of veterans who served over the past 10 years have had a difficult to very difficult time re-integrating into civilian life.

It’s not at all clear what accounts for soldiers’ growing readjustment problems. But I’d suggest that part of the answer might be found in that same Pew report. Despite 10 years of military conflict, over this time frame only half of 1 percent of adults have been in uniform; compare this with the 9 percent of adults who served during World War II. Military service among us is now at its lowest level in 70 years.

Not only do very few of us today join the military, but we know few people who have. Since the end of the draft in 1973, the nation has relied on a dwindling all-volunteer army with high rates of re-enlistment for its national security. Soldiers today are much more likely to look to the military for longer-term employment; the military today is a profession more than a tour of duty.

Changes in the size, composition and expectations of soldiers have resulted in military personnel who are increasingly isolated from civilian life. The Pew report finds that civilians today have less meaningful and sustained contact with those in uniform.

Soldiers in turn have fewer and more select ties to civilian life than was the case when short stints in the service were more broadly shared among the population.

One result has been the growing existence of military subcultures that are both self-contained and unfathomable to outsiders. For many civilians, those in uniform can seem like members of a strange cult best to avoid, rather than a representative group chosen to carry out our collective security needs.

This lack of civilian contact, along with the more prolonged exposure to military life that is typical among soldiers, can contribute to the ex-soldiers’ re-integration problems. Many have a harder time understanding and identifying with popular American culture and its norms; many too, have a tendency to feel superior to civilians and civilian culture.

Re-entry is also made even more difficult by the type of skills soldiers acquire. Often these don’t correspond with skills needed in civilian life. A disconnect between what soldiers develop during their military careers in terms of hard and soft skills and what the private sector values makes re-integrating into civilian life more challenging.

The cultural gap between civilian and military life also contributes to employment problems. As a recent article in The New York Times states it, “Employers and veterans seem to view each other as alien species.” A veteran job-seeker commented that employers fear “we’re all going to rage out.”

These differences between military and civilian experiences are larger today than ever before. The founder of the advocacy group Iraq and Afghanistan Veterans of America states that these differences amount to us “almost (living) on two different planets.”

As we draw down our forces in Iraq (and eventually Afghanistan), the challenges soldiers face of reintegrating into the mainstream will only grow. According to White House estimates, a million servicemen and women will make this transition over the next five years.

The military must be more candid in dealing with soldiers’ readjustment problems. Meanwhile, the other 99.5 percent of us should in turn assure that returning soldiers are welcomed back to civilian life with the ample training, health and mental health services, counseling assistance, and career advising needed to ease their reintegration back onto our planet.