Franklin James Cook

Culture of Stigma Is a Key Cause of Military, Veteran Suicides

In Policy, Prevention, Stigma on March 24, 2009 at 11:32 am

singleace_card-back1By Franklin Cook, SPNAC Editor

Ever since the Army announced that suicide in its ranks was at an all-time high last year, news outlets have been brimming with coverage about the causes and solutions for the tragedy unfolding among America’s active military and veterans. Several of the latest installments covered testimony before the Senate Armed Services Committee by some of the military’s top brass (SPNAC readers may refer to the transcripts,  or a webcast of the hearing). According to a Stars & Stripes report on the hearing, it “was designed to address plans to deal with the rate of military suicides, which is above the national average.”

Gen. Peter Chiarelli, vice chief of staff for the Army, called the suicide figures for his service “unacceptable” and fixing them “the most difficult and critical mission” of his military career. “The reality is, there is no simple solution. It is going to require a multi-disciplinary approach, and a team effort at every level of command and across all Army components, all services and jurisdictions, as well as partners out of our organization.”

An article on the hearing in Air Force Times summarizes the statistics that are behind the military’s and Veterans Administration’s alarm about suicide:

The Air Force lost 38 airmen to suicide in 2008, a rate of 11.5 suicides per 100,000 airmen. … In 2008, the Army reported 140 confirmed or suspected suicides. That’s 20.2 suicides per 100,000 troops — an all-time high that is nearly twice the national average of 11 suicides per 100,000 … The Navy reported 41 suicides in 2008, a rate of 11.6 per 100,000. The Marine Corps lost 41 Marines last year to confirmed or suspected suicides — up from 25 two years earlier — a rate of 19 per 100,000.

The hearing included testimony from Kathryn Power, director of the Center for Mental Health Services in the Department of Health and Human Services, who shared another potentially troubling indicator with the Senators:

More ominously, 780 callers to a national VA suicide prevention hot line in fiscal 2008 identified themselves as active-duty troops, [she] said. Since Oct. 1, an average of three hotline callers per day have identified themselves as being on active duty, Power said.

Sen. Lindsey Graham, R-S.C., said that indicates many conflicted troops continue to feel a sense of stigma over reporting suicidal thoughts to superiors or military mental health officials.

“When you’ve got this many people feeling they can’t talk to someone within the system, that’s a problem,” Graham said.

Another aspect of the challenge facing those who care for military personnel and veterans was highlighted at the hearing by Brian Altman of the Suicide Prevention Action Network (SPAN USA):

[He] said the services have made improvements on the issue in the last year. But they still need to hire more medical professionals to handle troops suffering from depression — a promise they’ve been making for several years, he said — and to do a better job educating about signs of suicidal thoughts.

“They’ve done a good job with troops … but many times those who commit suicide are not in theater,” he said. “So we would like to see them try and educate spouses and other family members, too, so they can identify the warning signs.”

A recent news release from U.S. Army Forces Command, reprinted in a “Special Report” at the blog Veterans Today, shows how ambitiously Army leadership is responding to suicide (and similar lists of programs are being implemented in the other military branches and in the VA):

On February 15, an Army stand-down began and continues through March 15 … The stand-down teaches peer-to-peer recognition of suicide warning signs and is available to all Army components and Department of the Army civilians … Phase I, an interactive video “Beyond the Front,” allows participants to choose options throughout the film, with the outcome based on their choices … Phase II of the training, also a video, “Shoulder to Shoulder,” reinforces the Army credo of “No Soldier Left Behind” and ties it to helping a Soldier in need …

One of the programs chaplains use is ACE, which stresses the “battle buddy” system. ACE [is] a mnemonic that represents the phrases, “Ask your buddy, Care for your buddy, Escort your buddy” …

[Also,] ASIST (Applied Suicide Intervention Skills Training) program … trains leaders on intervention and working with distressed Soldiers and Families. Army policy requires one ASIST-trained representative in every battalion.

Even with all of the programs coming down the line, Sen. Graham’s observation about stigma is emerging as the key roadblock for troops and small-unit leadership at the operational level. The power of stigma over help-seeking in military culture, in fact, may be the battle upon which winning the war against suicide depends. As Christopher Weaver points out in a post at ProPublica,

It’s a familiar refrain. Since 2003, yearly reports on the Army’s suicide rates have spurred similar news stories and similar reactions by Pentagon officials. Suicide-prevention initiatives — such as the “battle-buddy” program, which relied on ordinary soldiers to keep an eye on each other — have spawned in the wake of the grim statistics, but the numbers have only worsened.

Referring to a Jan. 29 article in the New York Times, Weaver writes,

[It] is absolutely critical to reach out to soldiers and tell them it is not wrong to reach out for help,” [Gen. Peter] Chiarelli told the Times. “We have to change our culture.”

The call for a change in culture also has echoes. A March 2008 report by the Army’s inspector general suggested a new “culture of support for psychological health.” And in April 2005, the Marine Corps Times reported that the Army’s surgeon general, Lt. Gen. Kevin Kiley, told a House Appropriations subcommittee, “That’s still part of our culture: Real men don’t see [mental health counselors]… I would like to see a culture that resets the force mentally.”

If stigma ingrained in military culture is a force that is stopping suicide prevention programs from working effectively, then the vital question to answer is, What is military (and civilian) leadership doing –besides issuing orders, which is a necessary but not sufficient step — to decisively lessen the stigma against help-seeking that is killing so many of those whose sacrifices make our freedom possible?

[The abridged URL for this post is  bit.ly/culturestigma .]

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  1. Stigma, and shame are a part of receiving “mental health” services. The psych dirty labels, and “mental” word ruin people’s lives forever. Psych labels are non-medical, and too often are given by non-medical psychologists who have not medical or scientific training whatsoever. The dismal record of psych services is clear. Careers, marriages, respect, are ruined. People are humiliated, and demeaned. Stigma is how psychs justify a feild that is unaccountable, unreliable, and not valid. It does not matter whether one is in the military or not, the legacy of mental health is failure, and underproductivity. The record is clear. All this is caaused by the fact that psychs are greedy, and want lifetime cash flow.

  2. The American Mental Health system has proven time after time that it cannot be trusted. It has a history of patient abuse cuased by staff members. Patients for years have been ostracised by the stigma generated by psych terminology. Greedy mental health professionals have taught the public well about the permanent pathology involved, and the average person is fully aware of stigma generated from receiving psych help. Let’s be honest that’s the reason in the first place for people refusing treatment, and the high suicide rate. In boot camp GI’s learn to respect themselve, and psychs take it away. Everyone knows that in order to receive psych treatment, one must give up their respect, and dignity. Psychs have absoulte power and; there is no love, and caring for humanity in psych “diagnoses”. There’s only groupthink generated disrespect, and dependence for the individual.

  3. I only wonder if newly induced protocol had been followed in the military, if my friends would be here, alive, today. It is sad when one reaches out for help and help is not given. The grief of suicide is nearly unbearable, but knowing it could have been prevented is eternal torment. Regardless of the threat of being labled, Military officials need to follow up on these reports. It is a matter of life and death for our soldiers and our loved ones.

  4. Psychologists are non-medical, and the only field they know anything about, is the field of “psychology” which is an unaccountable, unreliable, and invalid abstract entity. “Psychology” is not substantiated by any lab or blood test, and evidence shows it causes a lifetime of stigma, shame, and humiliation.

    For the military to “send out” in the field psychologists, to evaluate our brave veterans in the field, is a clinical error. Psychologists are incapable of diagnosing any phyical illness whatsoever, which could be causing a condition similar to PTSD. Once a psychologists finds PTSD, it stays as a so called “psychodiagnosis” forever, and very often a phyical illness, is the root cause of condition. A physical condition which is more accountably corrected, with much less personal shame to the patient.

    The facts show that the best professionals to diagnose, and supervise treatment are physicians, and nurses. Psychologists being non-medical are at the most helpers, who have a very limited knowledge-base, and who should be always strickly supervised by physicians, and nurses. Everyone knows that psychologists are in no way independent, and well-qualified healthcare profesionals.

  5. I am a veteran of the Vietnam war era. Soon after being honorably discharged I allowed myself to receive mental health services. It became the worst mistake that I ever made. I suffered from the stigma, and shame that everyone knows, results from involvement with mental health services. My marriage, my children, and my career suffered. I felt like an oddball. The mental health system likes to blame the military, and everyone elso about stigma, but the truth is their diagnoses are demeaning, and harm true rehabilitation.

  6. My son went for therpy after returning from Irag. He had seven sessions and was told he was fine. He died from suicide months latter. He tried to get help. I wonder where that counsler is now?

  7. I personally blame the military. The culture is such that a positive diagnosis for depression is automatically assumed to be a diagnosis of suicidal tendencies. The knee-jerk reaction is then sure to follow where a Soldier is removed from any responsibility and hidden away from the rest of the Army. This isn’t just conjecture this is my life. With 17.5 years in the army and a career of proving myself to be an expert in my field, I found myself at the Mental Health clinic to help me to deal with some very severe family issues. I asked for some down-time and maybe some anti-anxiety meds. The next thing I knew, I was on a plane to Water Reed Medical Center where I was diagnosed as having marital issues, but fit for duty. Upon my return to the desert, I was removed from every possible leadership position, given a job that is for Soldiers 3 ranks less than my own. I was moved to a base far away from the unit HQ and told I was unfit to command troops. I was basically given a command profile against having troop contact and sent away. I didn’t freak out. I didn’t do anything illegal or immoral. I simply was diagnosed with depression. Now my career for all intents and purposes is over while I wait for my time to end. I went to IG. JAG is next. Even if I am returned to my real duties, I have to deal with the command that sent me away. THAT is crazy. NOT ME!!!

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