Defense Department officials recognize that suicide prevention is not a one solution issue and are launching a new effort to address recommendations to help prevent these tragedies.
The Suicide Prevention and Response Independent Review Committee briefed Secretary of Defense Lloyd J. Austin III on its final report to help the military combat suicide.
Austin
released a memo March 16 calling on everyone in the department "to redouble our commitment to respond better to these tragedies and to prevent suicide."
While many of the committee's recommendation are still under consideration, the secretary ordered Pentagon officials to "expedite hiring for behavioral health professionals." Austin also formed a senior Suicide Prevention Implementation Working Group to assess "the advisability and feasibility" of implementing each of the remaining committee recommendations.
"What you'll find in this report is a comprehensive set of recommendations that will be implemented at all different levels within the military," said Gayle Iwamasa, a licensed psychologist and committee chairperson. "A lot of people, when they think of suicide, they think of it as an individual issue. But we used the format of the National Strategy for Suicide Prevention as sort of the structure for our report, because that national strategy is really comprehensive in looking at not just issues at the individual level, but issues at the family, community, cultural and organizational levels."
The committee made 127 recommendations and split them into high, moderate and low importance. Overall, 23 of the recommendations were of high importance, 79 were listed as moderate and 25 were of low importance. Many of the recommendations align with existing DOD initiatives, like the DOD integrated violence prevention framework and efforts to prevent sexual assault and harassment.
Congress mandated the committee last year. The lawmakers acted after statistics showed that, despite years of investment in programs to prevent service member suicides, the DOD suicide rate has shown an increasing trend over the past 15 years.
One of the committee members used an analogy to make a point about the effort. If a person lives beside a river and is always rescuing people from one place, maybe he should go upstream to see why people are falling in in the first place, he said.
The committee expressed support for DOD's integrated, comprehensive primary prevention approach that the members feel is an opportunity "to address that wide variety of upstream factors that, over time, combine and become exacerbated and lead to increased risk for suicide," Iwamasa said.
Financial concerns, relationship problems, alcohol abuse, shortages of mental health professionals, and housing hassles are all stressors that increase the risk of suicide-related behaviors, the committee members said.
"One of the things that we're seeing is that financial concerns were a large risk factor," one committee member said. "DOD has a number of wonderful interventions, but service members aren't getting into financial counseling until they are far into debt." The same thing applies to relationship problems, which have escalated by the time they realize they need help.
Some of the financial problems can be systemic. Committee members spoke of service members not getting paid for months. "In some cases, the DOD pay systems are not paying people in a timely fashion or are paying incorrectly," other committee members said. "There are constant delays in the reimbursement processes."
Getting upstream of these problems will be a challenge as the department has centralized much of the infrastructure at bases and posts. The committee members said there is no finance office a service member can walk into and get questions answered or have specialists iron out problems with requests and submissions. "If we want to get upstream then it's … how do we fix those problems so that the service member doesn't even experience financial strain in the first place?" One committee member said.
The shortage of mental health professionals is a nationwide problem. DOD is just one of the agencies trying to hire. The committee suggested ways to speed the process and work around the shortage.
These risk factors are all interconnected. "If you're not getting paid in a timely manner, it's hard to pay your mortgage," Iwamasa said. "That creates relationship conflict and strain."
Looking at the organizational underpinnings is important, she said, because these shortcomings "may be inadvertently increasing stress for service members," she continued. "The question then becomes how do you eliminate those sources of strain, so that it doesn't have this downstream effect on service members?"
"If we have experts and processes and systems that can fix those problems very early, they don't accumulate, they don't snowball and become more and more stressful," another committee member said.
The majority of military suicides involve firearms. Some 67% of active-component suicides, 74% of reserve forces suicides, and 76% of the suicides in the National Guard involve firearms.
Right now, public law forbids commanders from having a list of service members in their units who own firearms. "We heard many times from commanders after a suicide that they didn't even know the troop had a gun," a committee member said. The committee would like to see that law changed to allow commanders to have that information, while still protecting the rights of the service member to own the weapon.
The committee recommends DOD establish additional firearm safety training requirements. The committee also recommends a seven-day waiting period for any firearm purchase on DOD property and that all personally owned firearms be safely stored in a safe or with a locking device.
Alcohol abuse, sleep deprivation and excessive energy drink use can also add to suicide risk.
Many of these recommendations involve a cultural change, and that is never easy. "When you talk about drinking culture, when you talk about what's normative for sexual behavior and things like that, I don't know that many people from within are asking for it," said Craig Bryan, a clinical psychologist on the committee. "But we're coming in from the outside. And that's always a challenging thing. We've seen this in our history again and again and again when you try to impose change on a group that doesn't necessarily want it or ask for it."