Battleland

The Military’s Anti-Suicide Push: Old Wine, New Bottles

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September is suicide prevention month. The military has focused again on reducing suicide, which is absolutely appropriate. But I am troubled by the use of old, already tried/tired (failed?) methods for reducing suicide.

Soldiers and other service members do not need more suicide awareness-type campaigns. They are smart, and well aware of the suicide epidemic in the military.

We did suicide stand-downs three years ago. Posters and other tools on suicide prevention abound.

There have been multiple public service announcements from the Defense Center of Excellence and others on reducing stigma.

There are also the announcements on more money ($100 million, for example) to be pumped in treating post-traumatic stress disorder and traumatic brain injuries, both of which boost the risk of suicide. It all sounds good.

But, when I was on active duty, we dreaded these announcements of new programs and more money. That’s because we spent all our time figuring out how to spend the money in the short term.

Here’s a secret for those of you who have never served in uniform, or the federal government writ large: it is hard for the government to spend a large bolus of money in a short time. It distracts us from the mission of providing good patient care and developing good policy.

The civilian contractors, however, love these gobs of short-term money, because the easiest way to spend it is to hire more contractors to help you to figure out how to spend it. On them, typically.

So what should we do? It is clear there are no silver bullets, no easy answers. If there were, the various task forces would have ended the epidemic of suicide in the military some time ago.

But I believe, having studied PTSD and suicide in the military for a long time, that there are some solutions that have not been adequately explored and/or implemented (I have mentioned some of these in previous blogs.)

Two recent Institute of Medicine reports, which address treatment for PTSD and substance abuse, have many similar recommendations:

Examine the policies that promote stigma (such as that, in the Navy, you need to get general officer clearance to go to the firing range if you are on anti-depressants).

– Re-look at the security clearance process, which is widely viewed as a barrier to seeking treatment. (I get comments on this issue just about every time I post).

– Revise the deployment-limiting psychiatric medications policy, which precludes you from deployment if you have had any change in psychiatric medication or condition in the last three months.

– Drastically change the current humiliating process of getting treatment in the military behavioral health system. There has been some good progress in this arena, with Respect.mil and the National Intrepid Center of Excellence, but far more needs to be done.

– Further develop the promising, but not yet adequately researched, alternative forms of treatment for PTSD and pain, such as acupuncture, virtual reality, and animal-assisted therapy.

– Discuss openly the contributions of alcohol abuse and gun ownership to suicidal behavior.

– Do a research study on the suicides in the Guard and reserve. Are they related to combat, unemployment, the bad economy, lack of health care, or other factors? All of the above?

– Grow the behavioral-health workforce, both within and without the military.

– The Presidential effort, Joining Forces, and the SAMHSA (Substance Abuse and Mental Health Services Administration) Policy Academy efforts need to be fully joined into military efforts, instead of operating in their own silos.

– And, a solution which I do not advocate, but needs to be explored: consider a return to the draft.

Once again: this challenge is not a problem only for the military, or the Department of Veterans Affairs. It is a national problem that needs to be tackled, and solved, by the nation as a whole.

13 comments
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rexreed
rexreed

That's nice. So in a decade, 600MM spent on PTSD and TBI research; 3,4B of congressional funds dedicated for the purpose (used for who knows what) and we are putting have nothing to show but failure.

Perhaps you could write a column on who was responsible and why every effort seemingly failed from Battleminds to Reike.  Who cashed in the gobs of money?  Contractors are packed with your retired colleagues.  Maybe a piece of the revolving door of failure.  I failed in the military so I will cash in on my connections selling stuff that doesn't work to the DoD. The insider is hoping for a double dip once he or she is done with their 20.

Kelly stated Huff Po it was Rumsfeld's fault.  Ironically, nothing changed with the new administration.

anonguest7619
anonguest7619

the military will not demonstrate it truly gives a damn about getting people into see counselors until it changes its rules on security clearances. as long as they link treatment to any potential adverse affect on careers, people will either refuse to get help or start getting help, think better of it, and then stop again.

Justin Billot
Justin Billot

I would not disagree that the military and DOD should always evaluate new ways to prevent suicides and address psychological issues of troops. However, I would argue that the VA and DOD efforts have in general been unprecedented compared to the past to combat these problems.

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One source of hope: get people on the right meds (the dominant treatment) from the start instead of prescribing by trial amp; error. Psychiatric meds only work 1/3 of the time, amp; have side effects including suicide, leading soldiers to avoid treatment or lose hope after many ineffective treatments. 

Walter Reed is planning a clinical study of Depression, PTSD amp; TBI. It will measure the effectiveness of prescribing using an objective clinical info tool called PEER. Combining Dr-reported outcomes w/EEG, a std brain function test, PEER Reports medications the patient may be sensitive or resistant to, based on outcomes of similar patients. 

Led by Walter Reed as Principal Investigator, it will be one of the largest trials of psychiatric treatment effectiveness. 

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One source of hope: get people on the right meds (the dominant treatment) from the start instead of prescribing by trial amp; error. Psychiatric meds only work 1/3 of the time, amp; have side effects including suicide, leading soldiers to avoid treatment or lose hope after many ineffective treatments. 

Walter Reed is planning a clinical study of Depression, PTSD amp; TBI. It will measure the effectiveness of prescribing using an objective clinical info tool called PEER. Combining Dr-reported outcomes w/EEG, a std brain function test, PEER Reports medications the patient may be sensitive or resistant to, based on outcomes of similar patients. 

Led by Walter Reed as Principal Investigator, it will be one of the largest trials of psychiatric treatment effectiveness. 

Given this public health crisis, new solutions can't come soon enough.

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One new source of hope: get people on the right medications (the dominant treatment for warriors) from the start instead of prescribing by trial amp; error. Psychiatric meds only work 1/3 of the time, amp; have side effects including suicide, leading many soldiers to avoid treatment or lose hope after many ineffective treatments. 

Walter Reed is planning a 2,000 soldier clinical study of Depression, PTSD amp; TBI. It will measure the effectiveness of prescribing using an objective clinical info tool called PEER. Combining physician-reported outcomes w/EEG, a std test of brain function, PEER Reports highlight medications a patient may be sensitive or resistant to, based on the outcomes of patients with similar EEG findings.

Led by Walter Reed as Principal Investigator, it will be one of the largest trials of psychiatric treatment effectiveness in the last decade. 

Given this public health crisis, new solutions can't come soon enough.

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One new source of hope: get people on the right medications (the dominant treatment for warriors) from the start instead of prescribing by trial amp; error. Psychiatric meds only work 1/3 of the time, amp; have side effects including suicide, leading many soldiers to avoid treatment or lose hope after many ineffective treatments. 

Walter Reed is planning a 2,000 soldier clinical study of meds given to soldiers with Depression, PTSD amp; TBI. It will measure the effectiveness of prescribing using an objective clinical information tool called PEER. Combining physician-reported outcomes w/ EEG, a standard test of brain function, PEER Reports highlight medications a patient may be sensitive or resistant to, based on the outcomes of patients with similar EEG findings.

Led by Walter Reed as Principal Investigator, it will be one of the largest trials of psychiatric treatment effectiveness in the last decade. 

Given the emerging public health crisis we're facing with these disorders, new solutions can't come soon enough.

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One new source of hope: get people on the right medications (the dominant treatment for warriors) from the start instead of prescribing by trial amp; error. Psychiatric meds only work 1/3 of the time, amp; have side effects including suicide, leading many soldiers to avoid treatment or lose hope after many ineffective treatments. 

Walter Reed NMMC is planning a 2,000 soldier clinical study of meds given to soldiers with Depression, PTSD and Traumatic Brain Injury. The trial will measure the effectiveness of prescribing using an objective clinical information tool called PEER. Combining physician-reported outcomes with EEG, a standard test of brain function, PEER Reports highlight medications a patient may be sensitive or resistant to, based on the outcomes of patients with similar EEG findings.

Several military treatment facilities will conduct the study, led by Walter Reed as Principal Investigator. It will be one of the largest trials of psychiatric treatment effectiveness in the last decade. 

Given the emerging public health crisis we're facing with these disorders, new solutions can't come soon enough.

DarthWhatever
DarthWhatever

What kind of leadership and working conditions were all these suicidal soldiers subjected to?  We need to quit focusing so much on fixing damage that's been done and instead figure out what the root of the problem is.  Another power point presentation about suicide prevention isn't going to do a damn bit of good if the problem isn't the individual but the situation the individual is in.

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One new source of hope: getting people on the right medications (the dominant treatment for these warriors) from the beginning instead of prescribing by trial amp; error. This is a critical issue because psychiatric medications only work one-third of the time, leading many soldiers to avoid treatment. Or to lose hope after many ineffective treatments -- results are often many months or years away using trial and error therapy, with side-effects including, in some cases, suicide. 

Walter Reed National Military Medical Center is planning a 2,000 soldier clinical study of medications given to soldiers with Depression, PTSD and Traumatic Brain Injury. The trial will measure the effectiveness of prescribing using a clinical information tool called PEER. The system combines historical, physician-reported outcomes with EEG, a standard test of brain function. PEER Reports provide objective information to physicians about which medications a patient may be sensitive or resistant to, based on the outcomes of patients with similar EEG findings.

The study will be conducted at several military treatment facilities, led by Walter Reed as Principal Investigator. It will be one of the largest trials of psychiatric treatment effectiveness in the last decade. 

President Obama made rapid improvement in treatment outcomes for these mental disorders the focus of his recent Executive Order, and Secretary of Defense Leon Panetta compares it to the military's lead role in development of the internet, GPS, and the space program. Given the emerging public health crisis we're facing with these disorders, new solutions can't come soon enough.

Prakash Iyangar
Prakash Iyangar

can you comment on what is the idea of how a draft would help reducing stress?? just by increasing the number of people available for duty? 

PTSDinfo
PTSDinfo

Excellent recommendations from someone who should know. 

One new source of hope: getting people on the right medications (the dominant treatment for these warriors) from the beginning instead of prescribing by trial amp; error. This is a critical issue because psychiatric medications only work one-third of the time, leading many soldiers to avoid treatment. Or to lose hope after many ineffective treatments -- results are often many months or years away using trial and error therapy, with side-effects including, in some cases, suicide. 

Walter Reed National Military Medical Center is planning a 2,000 soldier clinical study of medications given to soldiers with Depression, PTSD and Traumatic Brain Injury. The trial will measure the effectiveness of prescribing using a clinical information tool called PEER. The system combines historical, physician-reported outcomes with EEG, a standard test of brain function. PEER Reports provide objective information to physicians about which medications a patient may be sensitive or resistant to, based on the outcomes of patients with similar EEG findings.

The study will be conducted at several military treatment facilities, led by Walter Reed as Principal Investigator. It will be one of the largest trials of psychiatric treatment effectiveness in the last decade. 

President Obama made rapid improvement in treatment outcomes for these mental disorders the focus of his recent Executive Order, and Secretary of Defense Leon Panetta compares it to the military's lead role in development of the internet, GPS, and the space program. Given the emerging public health crisis we're facing with these disorders, new solutions can't come soon enough.

Marjorie Morrison
Marjorie Morrison

Excellent opinion! I couldn't agree with you more.  Especially, "The Presidential effort, Joining Forces, and the SAMHSA (Substance Abuse and Mental Health Services Administration) Policy Academy efforts need to be fully joined into military efforts, instead of operating in their own silos."  The folks at the top have to start taking to those on the ground. Thanks for putting this out there.