End­ing mil­i­tary sui­cides

Any­thing short of an all-out com­mit­ment is a to­ken ef­fort.

Los Angeles Times - - OPINION - By John Bate­son John Bate­son was ex­ec­u­tive direc­tor of a na­tion­ally cer­ti­fied sui­cide pre­ven­tion cen­ter in the San Fran­cisco Bay Area for 16 years. His lat­est book is “The Last and Great­est Battle: Find­ing the Will, Com­mit­ment, and Strat­egy to End Mil­i­tar

Sui­cides by ac­tive-duty troops and vet­er­ans are at lev­els that would have been un­think­able a gen­er­a­tion ago. Each day, on av­er­age, a cur­rent ser­vice mem­ber dies by sui­cide, and each hour a vet­eran does the same.

In re­sponse, Pres­i­dent Obama signed the Clay Hunt Sui­cide Pre­ven­tion for Amer­i­can Vet­er­ans Act in Fe­bru­ary. The act aims to make in­for­ma­tion on sui­cide pre­ven­tion more eas­ily avail­able to vet­er­ans; it of­fers fi­nan­cial in­cen­tives to men­tal health pro­fes­sion­als who work with vets; and it re­quires an an­nual eval­u­a­tion of the mil­i­tary’s men­tal health pro­grams by an in­de­pen­dent source.

The law is com­mend­able, but it won’t come close to end­ing mil­i­tary sui­cides. That would re­quire rad­i­cal changes in the poli­cies, pro­ce­dures, at­ti­tudes and cul­ture in two of our big­gest bu­reau­cra­cies: the de­part­ments of De­fense and Vet­er­ans Af­fairs.

Fif­teen years ago, the sui­cide rate among pa­tients in a large HMO in Detroit was seven times the na­tional av­er­age. Its lead­ers de­cided to try to end sui­cides — not just re­duce them but end them. In four years, the in­ci­dence of sui­cide at the HMO was re­duced 75%; with more tin­ker­ing, the rate went down to zero, and has stayed there, at last count, for 2 1⁄2 years. The dif­fer­ence was an all-out com­mit­ment to the cause.

Ev­ery time a pa­tient sought care, re­gard­less of the rea­son, he or she was as­sessed for sui­cide risk. Ev­ery em­ployee who came in con­tact with pa­tients was rig­or­ously trained in sui­cide pre­ven­tion. Spe­cific in­ter­ven­tions were es­tab­lished for each of three risk lev­els.

The HMO also im­ple­mented mea­sures to pro­vide timely care by en­abling pa­tients to get im­me­di­ate help through email with physi­cians, to make same-day med­i­cal ap­point­ments and to get pre­scrip­tions filled the same day too.

A sim­i­lar com­mit­ment by the mil­i­tary could achieve dra­matic re­sults, at least among ac­tive-duty troops. Th­ese troops are in the sys­tem now, their ac­tiv­i­ties are be­ing mon­i­tored reg­u­larly, so there are plenty of op­por­tu­ni­ties for as­sess­ment and treat­ment.

If the mil­i­tary fol­lowed the Detroit model, all troops would be eval­u­ated for post-trau­matic stress and sui­cide risk when they re­turn home, not just those who ask for help. Eval­u­a­tions would hap­pen more than once; they would be in per­son and one-on-one, not with writ­ten ques­tion­naires. In ad­di­tion, fam­i­lies would be in­ter­viewed, separately and con­fi­den­tially.

And treat­ment and claims would be ex­pe­dited. Vet­er­ans shouldn’t have to wait a year or more to re­ceive health­care or have their claims pro­cessed.

Then there is the mat­ter of stigma. It’s not the mil­i­tary’s re­spon­si­bil­ity alone to des­tig­ma­tize psy­cho­log­i­cal prob­lems, but there are steps the mil­i­tary can take.

Ser­vice mem­bers with PTSD who are able to man­age it should be strongly con­sid­ered for pro­mo­tions just as though they had re­cov­ered from phys­i­cal wounds. Their abil­ity to over­come men­tal in­jury should be rec­og­nized, so it in­spires oth­ers.

Pur­ple Hearts are awarded to sol­diers who suf­fer a se­ri­ous phys­i­cal wound in com­bat; they should also be awarded to those who suf­fer se­ri­ous men­tal health in­juries in com­bat. In­juries are in­juries and none should be min­i­mized.

Fi­nally, just as good-con­duct medals and com­bat awards are be­stowed on troops, so should com­men­da­tions be given when sol­diers rec­og­nize that their com­rades need help and act on their be­half.

This is just a start. To keep its troops men­tally healthy, the De­fense Depart­ment must re­duce the num­ber and du­ra­tion of com­bat de­ploy­ments and do more to pre­pare troops for as­sy­met­ri­cal war­fare. It must help them ad­just to life when they come home — with jobs, hous­ing, loans and legal as­sis­tance. It must en­force, not just ap­prove, a pol­icy of zero tol­er­ance re­lated to sex­ual ha­rass­ment and as­sault.

Each el­e­ment has a price, and col­lec­tively the cost will be as­tro­nom­i­cal. We must be pre­pared to pay it if we are sin­cere in our com­mit­ment to sup­port our troops.

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