Suicide-Prevention Program Recommendations don't go far enough

Twenty-nine years ago, I was introduced to Post Traumatic Stress Disorder, initiated into the Vietnam War by a 30 year old veteran. It was 11 years after he came back home part way. Aside from living with it, I've spent all these years tracking it. As an expert, I can tell you that we have never seen so many studies and attempts to help the veterans heal as we have today. While this fills me with great hope, it also serves as warnings because with all that is being done, there are still increased numbers of veterans reaching the point where they feel so much hopelessness, they are on the brink of suicide.

The Suicide Prevention Hotline received over 55,000 calls in the first year according to a report from SAMHSA, Substance Abuse and Mental Health Services.

As of March 3, 2011 the Suicide Prevention Hotline numbers

To date, more than 379,000 callers have called the Veterans Suicide Prevention Hotline, and more than 200,000 of these callers have identified themselves as Veterans or family members or friends of Veterans. To date, the hotline has led to more than 13,000 rescues of actively suicidal Veterans.

Yet there are still 18 veterans a day committing suicide. What is even more troubling is the fact that until this month, the active duty military did not have access to suicide prevention.

Suicide hotline available for deployed soldiers

Even if it was possible to track all the suicides and attempted suicides, we'd never really know all of them. There are drug overdose deaths that are never really clear if they were accidental or suicide. Accidents are never really clear when they result in death. No one is checking on the incidents involving law enforcement when a veteran with PTSD is involved.

Why, after all these years did over 379,000 calls have to be made in the first place and why were over 200,000 of them from veterans? Why does it still reach that level of pain this keeps happening?

Because the programs they have in place are not working even though they are clearly helping some. What is missing? The families are. Their role in all of this is often overlooked and they are one of the most important resources.


It is troubling something like this is found on the National Suicide Prevention Hotline site.

The Lifeline is featured in Marvel comic
Captain America: A Little Help

"Super heroes fight a lot of battles, but there are few more important than combating suicide," said Tom Brevoort, Senior Vice-President of Publishing. "That’s why we're making Captain America: A Little Help available for free via our digital comics outlets. If even one person calls this number instead of doing something very tragic, we know that means we succeeded."

Suicide Prevention Lifeline.org page tells veterans to press 1 to talk. Yet on the same site, the same page, Captain America is right there at the bottom and he's battling a bunch of guys dressed in green. This is not a good idea no matter who it was intended for to show up on the same page telling veterans to seek help.

Without knowing what to do, families like mine did the best we could without any support or knowledge at all. Most of the mistakes made living with combat PTSD, were all made many years ago and we learned from them. We are yet one more untapped resource in helping the veterans heal because we live with it everyday. Many wives have been married for 30 or 40 years, keeping their veteran alive and raising their families with nothing to lean on other than love. I can tell you first hand, back when all this was new to me, I would have paid any price for the resources available today, especially the online support but too many do not take advantage of it. These are lifelines! They need to reach for them but their excuse is, they have enough to worry about so they discover PTSD when it is too late to avoid a lot of anguish.

Families can make it better when they understand but they are left out of the healing with mental health workers. They need to be included in the therapy as much as they need to be clued in.

These are the key recommendations Rand offered. Families are missing from the action.

Raising awareness and promoting self-care;
Identifying people at high risk, including screening for mental health problems;
Eliminating actual or perceived barriers to quality behavioral health care;
Providing high-quality mental health treatment and specific interventions focused on suicide when needed;
Restricting access to firearms and other lethal means, with attention to how lethal medications are packaged and how door hinges and shower rods are constructed; and
Responding appropriately when suicides occur.

While these are very important, they miss a big one and that is the family. Family can be relatives or it can be very close friends, because facing reality there are many serving without a strong family behind them. We see it when they come home from deployment. They get off the bus without a spouse to greet them, without Mom or Dad showing up to hug them, so they stand with their friends. Their friends are as close to family as there is.



Yet families are not the only problem. There have been suicide reports from across the country when the family knew what PTSD was, got the to go for help and offered all the support in the world, but it was still not enough. This suggests the programs offered to help them heal were not good enough. One more indication changes have to be made to make sure the programs live up to the challenge these veterans come home with.

Study Makes Suicide-Prevention Program Recommendations
By Donna Miles
American Forces Press Service

HAMPTON, Va., March 25, 2011 – A new study commissioned by the Defense Department affirms many of the suicide-prevention efforts being made within DOD and the military services and recommends ways to strengthen them.

In preparing “The War Within: Suicide Prevention in the U.S. Military,” the Rand National Defense Research Institute examined data on military suicides, identified what scientific literature and leaders in the field consider the best prevention strategies and recommended ways to ensure existing programs reflect the state of the art, officials said.

“This is a very thorough effort,” Dr. Mark Barnes, director of the resilience and prevention directorate at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, said of the report. “Rand interviewed each of the services and went outside the military to look at suicide-prevention practices and identified gaps for the way ahead [and] recommendations for the military suicide-prevention programs.”

The study’s findings track closely with those in the Defense Department’s own DOD Suicide Task Force Report, Barnes told military health care professionals attending the first Armed Forces Public Health Conference held here this week.

“There is no disagreement. They are very complimentary in what they are recommending,” he said. “So we have a nice resource here with quality information that our suicide-prevention folks can refer to as we move forward with the task force recommendations.”

Navy Capt. Paul Hammer, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, called the Rand report an important tool in helping the Defense Department better confront an issue it takes “very seriously.”

“The Rand study helps us to identify areas that need improvement so that we can continue to provide the most comprehensive health care for our service members –- from the inside out,” he said.

The study, written for health policy officials and suicide-prevention program managers, recognized critical factors in a comprehensive prevention program. These include:

-- Raising awareness and promoting self-care;
-- Identifying people at high risk, including screening for mental health problems;
-- Eliminating actual or perceived barriers to quality behavioral health care;
-- Providing high-quality mental health treatment and specific interventions focused on suicide when needed;
-- Restricting access to firearms and other lethal means, with attention to how lethal medications are packaged and how door hinges and shower rods are constructed; and
-- Responding appropriately when suicides occur.

Evaluating the Defense Department’s suicide prevention programs, the study cited the potential benefit of a new DOD-wide surveillance program being used to track suicides and suicide attempts. The DOD Suicide Event Report replaced each service’s individual suicide-reporting system, Barnes explained, helping to ensure “apples to apples” comparisons as information is shared across the services.

“This is a data issue,” he said. “We need good data. The data informs us in how to be effective with prevention and health promotion. So we are continually improving our data systems.”

Rand also called for an evaluation of existing suicide prevention programs, along with a requirement that any new initiatives include an evaluation plan. Barnes acknowledged the challenge of assessing programs’ effectiveness, but called closer collaboration and information sharing across the Defense Department and services a positive step toward sharing best practices and determining what works.

The Rand study recognizes most military suicide-prevention programs’ focus on raising awareness, including telling people where to get help and helping them recognize peers in distress.

However, it emphasizes the importance of also teaching military members how to recognize their own problems and refer themselves if needed to a behavioral health professional or chaplain.

“Raising awareness and promoting self-care is something we do and we can do better,” Barnes said, noting the value of resilience campaigns. “The ideas is to give people skills,” and know how to recognize signs of risk in themselves as well as others, and to know what to do.

The report also identified the importance of partnerships between agencies and organizations responsible for mental health and substance use and other known risk factors for suicide.

“We do fairly well in terms of partnerships,” Barnes said. “One area we are looking at is, on an installation, how well do all the different partners work together in the suicide [prevention] mission? Because often times you have … one person who is the suicide prevention person on an installation. They are not going to be able to check in on everybody. It is really the whole installation that needs to be on board to be effective with this.”

The study also cited the need to ensure there’s no gap in services provided during military members’ transitions -- between military bases, between commands or between active and reserve status.

“Ensuring a continuity of services and care is really important,” Barnes said. “One of the times of increased vulnerability is during transitions. … And we need to be covering all the gaps like this proactively for our service members and their families.”

The study called for formal guidance for commanders so they know how to respond to suicide and suicide attempts. It recognized the lack of any direct policy within the services and the risks of handling these situations improperly.

“It is really about our leadership,” Barnes said. “We need to empower our leadership, because they set the example. They set the tone. So we have to give them the tools. We need to give them the information, the data, so they know what is going on, where we think is the right direction to go, and then get behind them.”

One more important factor in all of this is who was behind all of these programs starting in the first place. Vietnam veterans and their families pushed for help in the beginning. Still we wouldn't know as much as we do now about how huge the problem is had it not been for groups like Veterans For Common Sense and Paul Sullivan making sure they got the right information. They have been filing Freedom of Information Act requests for years to find out what the truth is and it has been pretty dark for the veterans behind the idyllic image of veterans joyous homecomings.

The VA and the DOD can come out with programs without providing any proof these programs work and the general public would take it at face value. The truth would be hidden behind the claims, as it had been until VCS fought to make sure the truth was told. The same truth hundreds of thousands of families live with year after year when the rest of the country has forgotten all about the battles they were sent to fight.

There is hope in all of this as long as the American people refuse to allow more to die when they come home from war than during it.
Demand answers from the media.

Why are so many still committing suicide when so many have been calling suicide prevention?
With all the programs millions of tax payer dollars fund, why aren't they working?
Why do veterans still feel on the brink of suicide they need to call for help?
With all the attempts to address the stigma, why are so many still afraid to ask for help?
Why are so many getting help still committing suicide?

There are very serious questions needing to be asked, but the media doesn't seem interested enough in asking or they lack a clear understanding to even know how serious all of this is. Make sure they discover what the reality is for too many when they come home before it is too late for too many more.