By Army Staff Sgt. Jim Greenhill
National Guard Bureau
WASHINGTON (5/14/10) - The National Guard is aggressively addressing a spike in Citizen-Soldier and –Airman suicides that reflects a trend throughout the military.
“We are alarmed by the suicide rates we’re seeing inside the Army National Guard,” Army Maj. Gen. Raymond Carpenter, the component’s acting director, told the Senate Appropriations Committee’s subcommittee on defense in March. “Almost half of the suicides we’re experiencing are from Soldiers who haven’t even deployed. There’s more to this than just the mobilization and deployment piece.”
Last year, 65 Army National Guard Soldiers killed themselves; 15 Air National Guard Airmen died by suicide.
The trend continues. The Army National Guard confirmed 34 suicides through April 26. The Air Guard confirmed six.
Of the 34 Army National Guard deaths so far this year, 20 had never deployed, Guard officials reported. Of the six Air National Guard suicides, four had not deployed.
The increases echo a spike throughout the armed forces.
“As I look at the numbers for each service, the rates have gone up per capita at about the same rate over the past four or five years for every service,” Navy Adm. Mike Mullen, chairman of the Joint Chiefs of staff, said in January, according to American Forces Press Service. “This isn’t just a ground-force problem.”
As has happened in other medical specialties, such as trauma care, the military is making a leading contribution to suicidology.
“The subject of suicide is one of tremendous difficulty and challenge and understanding,” Mullen said. “Certainly, … with the rise in the numbers in all the services since these wars, [Defense Department officials have] started to really look at the causes and get to a point where we can prevent this and understand this.”
The Army and Air National Guard investigate every suicide.
“We do a detailed analysis on each one of these suicides because we want to know what happened in that individual’s life that caused them to think that suicide was the best option,” Air Force Lt. Gen. Harry Wyatt III, director of the Air National Guard, told the House Appropriations Subcommittee on Defense in April.
“What we’ve found is that they’ve had some sort of significant event inside of their own life, either they lost their girlfriend, they lost their job,” Wyatt said.
The numbers of suicidal servicemembers who have not deployed and analysis of the apparent reasons behind suicides and suicide attempts led Army Col. Gregg Bliss, chief of the Army National Guard’s Soldier and Family Support Division, to conclude that while the National Guard’s expanding suicide prevention programs are important, instilling resiliency throughout the Guard is critical.
One way to define resiliency: The ability to grow and thrive in the face of challenges and bounce back from adversity.
“Resilience has benefits to all Guard Soldiers and families,” Bliss said.
Army Maj. Gen. William Wofford, adjutant general of the Arkansas National Guard – a state that makes for a case study in a comprehensive response to the suicide spike, that went above and beyond by providing services to all Arkansas servicemembers regardless of component and led a statewide effort to improve suicide prevention for all Arkansas residents – likes the term “operational stress.”
Air Force Gen. Craig McKinley, the chief of the National Guard Bureau, discussed these stressors at the March Senate hearing.
“The stresses, the strains, the financial difficulties, the times we live in, the stress on the family, the fact that we’ve had continuous rotations, obviously have created an environment where many of our young Soldiers and Airmen struggle, … ” McKinley said. “Our deploying Soldiers and Airmen are facing challenges that none of us … certainly ever did in our military careers.”
How the National Guard’s current suicide rate compares to the rate in the national civilian population is hard to measure. The last comprehensive national study on suicide was conducted by the Centers for Disease Control in 2006, so they are too outdated to give a meaningful comparison.
Suicide is notoriously difficult to quantify, in part because of a tendency for some coroners, who determine causes of death, to make a ruling other than suicide out of deference to family wishes.
It also is an underpublicized epidemic that was claiming more than 31,000 American lives annually at the time of the 2006 CDC study. CDC numbers from 2002 found suicide was the second-leading cause of death in the 25-34 age group and the third leading among 10- to 24-year-olds.
Media policies – aimed at respecting privacy and preventing copycat suicides, a particular problem among teens – typically prohibit reporting suicide unless it occurs in a public place or involves a public figure. Obituaries frequently fail to list suicide as the cause of death.
Air Force Maj. James Coker, chief of the Air National Guard’s public health and prevention branch, suggests that, even with the spike in suicides, the overall suicide rate remains lower for the Air Guard than for the civilian population, based on the 2006 CDC study.
“An Air Force epidemiological analysis shows that, when we age- and gender-adjust civilian suicide rates to compare to a military population, the civilian data after age- and gender-adjustment is 19.2 per 100,000 personnel,” Coker said. The 2009 Air Guard rate was 13.89 per 100,000 Airmen. “Based on statistical measures, the ANG is below the 2006 CDC age- and gender-adjusted civilian suicide rate reported.”
Just as the civilian numbers are likely underestimated because of coroner rulings, the same holds true in the National Guard.
On the other hand, improved tracking within the Guard may have contributed to increased reports of Guard suicides.
While it is also hard to quantify why Soldiers and Airmen kill themselves – they are not around to explain – observation by those working the issue every day and case reviews suggest some answers.
“The majority of [Army National Guard] suicides were committed by young, white males who had relationship issues and/or financial issues,” Bliss said.
“Based on analysis, deployment does not appear to be a contributing suicide risk factor,” Coker said of Air Guard suicides. Rather, they seem to stem from similar factors found in the Army Guard: failed relationships, legal problems, job problems and financial problems – similar to findings in studies of civilian suicide motivations.
“I cannot recall a single instance of a suicide attempt or completion that did not in some way involve a family breakup, loss of a significant other,” said Dr. Tina McClain, associate chief of staff for mental health for the Central Arkansas Veterans Healthcare System. “They all have that as a common denominator.”
Army Capt. Tanya Phillips, suicide prevention program manager for the Arkansas National Guard, who deals with troubled servicemembers daily, echoed her adjutant general, seeing underlying societal issues.
“The resilience is not learned as it might have been in past generations,” she said.
“They want immediate gratification,” Wofford said. “If they can’t fix the problem right now, and they haven’t got the [skills] to deal with relationship issues, [they say,] ‘I have no hope, because my girlfriend broke up with me.’ There’s something missing there.”
Guard leaders are concluding that “something missing” is resiliency and that it is showing up as a problem in the ranks because the military is a reflection of society and lack of resiliency is a national problem.
“The younger generation has grown up in a society where everything is at their fingertips – literally a click away,” said Air Force Command Chief Master Sgt. Denise Jelinski-Hall, the National Guard’s senior enlisted leader. “Resiliency is not something that you can instantly acquire. It is a learned behavior that one acquires over time through education, training and experience.”
“Our intent is to … create resiliency and establish a more hardy and life-skill capable force,” Bliss said. “The Army Guard’s goal is to prevent all negative behaviors, not just suicide.”
“Our Air National Guard leadership is taking a very proactive role,” Coker said.
Individual state initiatives include California embedding counselors with Guardmembers during monthly drills, pioneering resiliency programs in Kansas and New Hampshire creating a collaboration of state and federal programs that has been copied by other states, including Arkansas.
Following a Defense Department recommendation, the National Guard Bureau is providing directors of psychological health at every joint force headquarters in every state and territory and the District of Columbia and at the headquarters facilities of both the Army and Air National Guard.
Those directors offer guidance to Guard leaders on mental health issues, provide training and meet with individual Guardmembers. They evaluated about 2,500 Guardmembers in the last year, said Public Health Service Capt. Joan Hunter, NGB’s director of psychological health.
“The top two presenting concerns are family and marital issues [or] psychiatric concern,” Hunter said. The psychiatric issues tend to center on post traumatic stress disorder, traumatic brain injury or depression, she said.
“It’s very important for us in psychological health … to do our best to get out ahead of it, so we’re not constantly reacting to a tragedy,” Hunter said.
The National Guard Bureau also is promoting a suicide prevention hotline at (800) 273-TALK; partnering with the Department of Health and Human Services to highlight best practices in the states; conducting a beta test in two states that uses computer mapping to match Guardmembers with local mental health resources; and studying adding additional behavioral health providers in the states.
Soldier and Airman care can be a retention issue. One noncommissioned officer interviewed for these reports said he does not plan to re-enlist after a multiple-deployment, 14-year career, despite his pride in service – and despite high praise from higher-ranking Soldiers asked about his performance – because he felt troubled Soldiers had been poorly served within his unit.
“Follow what the Army has said to do,” he said. “If we do that, [they’ll] be taken care of.”
He suggested there sometimes is a reluctance to appropriately report issues higher up the chain because of a perception by mid-level commanders that troubled Soldiers reflect poorly on the unit and therefore on their superiors. “You can’t tell me that’s the wishes of the general,” he said. “That’s the interpretation.”
“There is a hesitancy on many levels – personal, organizational – to someone seeking assistance for mental health,” Hunter said. “If somebody fell down and broke their leg, they wouldn’t be afraid to ask their commander for time off for the bone to heal. We have to start looking at mental health the same way.
“It’s not a reflection on an individual commander because one of his troops is being challenged … and what we’re trying very hard to educate our commanders with is the fact that many people are being exposed to horrendous things and it’s very normal for them to have a reaction the way they are.
“Where the rubber meets the road is our first sergeants and our senior enlisted … they are the key to the success of behavioral health in the National Guard.”
Interviews for these reports suggested a reluctance by servicemembers to seek help because they do not want to appear weak to their colleagues, feel they should be able to handle issues themselves and fear their careers will be negatively impacted.
“Asking for help may very well be the bravest thing you can do,” Mullen noted in a recent Facebook posting reminding servicemembers that May is Mental Health Month.
“Leaders at all levels need to encourage their Soldiers, Airmen and families to seek help,” Jelinski-Hall said. “Recognizing that you or your family needs help should be viewed as a strength. It takes courage to say, ‘I need help.’ By word and action, it is up to leadership to show servicemembers that their career will not be affected because they asked for assistance. Servicemembers need to trust that leadership will do right by them and they will continue to have a successful career.”
One Arkansas servicemember who attempted suicide said he felt his struggle made it easier for other members of his unit to seek help because they saw him ask and how he was treated when he did so.
“They’re not going to have much of a military career if they commit suicide,” McClain said.
Like other leaders, Jelinski-Hall said the pace of life and replacement of one-on-one interaction with e-mails, text messages and social networking sites may be contributing to decreased resilience.
“It is essential that we as leaders – especially in today’s era of BlackBerries, Twitter, e-mail and texting – remember the leadership practices that have always been successful,” she said. “The only way we can truly help our Soldiers, Airmen and their families is by really getting to know them. The only way we get to know them is to talk with them one-on-one, face-to-face and ask the tough questions.
“That way we not only hear their words, but we can see their faces, look into their eyes, understand them and provide them with the leadership they should expect and definitely deserve. All the modern technology in the world will not replace direct and meaningful contact with our people.”
The unique nature of the National Guard also means reaching out to families, businesses and community organizations for help, as states such as Arkansas have done.
“We’ve only got these guys two days a month,” said Army Capt. Chris Heathscott, state public affairs officer. “By the time we find a problem, it’s too late.”
Hunter said 6,400 members of the Army National Guard are the only Guardmembers who live in their ZIP code, a level of dispersement unknown in the active duty force.
“[The VA] can’t be everywhere at once,” McClain said. “The Guard can’t be everywhere at once. We need as many community leaders – we want those first responders, the law enforcement or the clergy or the counselors at school – to be involved and be on the same page and for us to provide them the support that they need in order to provide an appropriate intervention.
“What will help is if we have everyone at a high level of suspicion for suicidality. Then we’re more likely to recognize those warning signs.
“The main thing you can do is not keep it to yourself. You need to enlist the help of a professional, whether it’s a mental health provider or your commanding officer. Someone needs to know besides you.
“The main thing is to enlist any support, where you are, that’s available – immediately.”
Said Hunter, “People who are contemplating suicide don’t necessarily want to end their biological life. Whatever is happening in their life, they don’t see any options. … You move them out of that crisis point … you’ve succeeded in saving a life – but you’ve also put a life back on track.”