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Reframing Suicide in the Military

Since 2001, the suicide rate among members of our military has increased dramatically. This increase occurred despite improving behavioral health conditions for American forces serving in Iraq and Afghanistan. (1) The public response to this alarming and paradoxical trend largely has been to blame the usual suspects when bad things happen in our military: stress, the strain of intense operations and repetitive deployments, and the hardships of military life. Proposals to address the problem of suicide have also trod familiar ground: more money, more programs, more chaplains, expansion of mental health resources, more research on Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), new training modules, increased awareness, and better screening and treatment for those we think are at risk. Nevertheless, suicides continue to occur at unusually high rates in the military. We will argue that our current understanding of this problem is incomplete, and that, as a nation, our approach to suicide in the military needs to be refrained. Scope of the Problem The suicide rate in the United States in 2001 was about 10.7 per 100,000 and in 2006 was virtually unchanged at 11.1 per 100,000, translating into approximately 30,000 deaths by suicide each year. In contrast to this stability, the suicide rate in the Army was 9.0 per 100,000 in 2001 but rose sharply to 19.3 per 100,000 in 2008. Rates in the Marine Corps were 16.7 in 2001 and 19.9 per 100,000 in 2008. (2) In fiscal year 2009, the Army lost more soldiers to suicide and accidental death than to combat fatalities? Meanwhile, during this same period, rates in the Navy and Air Force remained relatively steady (10.0 to 11.7 for the Navy and 10.1 to 12.6 for the Air Force). In sum, virtually all of the increase in the DOD suicide rate has taken place in the two ground services that have borne the brunt of the deployment burden in Iraq and Afghanistan. This would seem to provide an initial clue about where to start and what to consider in accounting for the overall increase in military suicides. Current Approaches The RAND Corporation recently issued a report on suicide in the military that begins with the assumption that the increase in suicide rates is attributable to stress, particularly stress associated with repetitive deployments. For example, the opening paragraph of the RAND report's summary observes: Since late 2001, U.S. military forces have been engaged in conflicts around the globe, most notably in Iraq and Afghanistan. These conflicts have exacted a substantial toll on soldiers, marines, sailors, and airmen, and this toll goes beyond the well-publicized casualty figures. It extends to the stress that repetitive deployments can have on the individual service member and his or her family. This stress can manifest itself in different ways--increased divorce rates, spouse and child abuse, mental distress, substance abuse--but one of the most troubling manifestations is suicides, which are increasing across the Department of Defense (DoD). (4) Given the RAND report's strong emphasis on repetitive deployments as a stressor associated with increased suicides, it is perhaps surprising to discover that the 2009 Department of Defense Suicide Evaluation Report finds only 7 percent of military suicides occurred among servicemembers with multiple deployments. (5) According to the same DOD report, while 51 percent of military suicides had been deployed at some time to Iraq or Afghanistan, only 17 percent had experienced combat. Many suicides happen among junior enlisted soldiers; repetitive deployments are more common among senior noncommissioned officers. In 2010, the Army released its own comprehensive Health Promotion, Risk Reduction, Suicide Prevention Report (Army HP/RR/SP Report). (6) Carefully reviewing a wealth of data, the report emphasizes two factors: (1) lapses in garrison leadership supervision and control, and (2) the lowering of recruitment standards (through increased use of waivers) during the years of high operational tempo, thereby admitting more recruits given to "high risk behavior" (alcohol or drug abuse and brushes with the law). …