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.)
— 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.