No easy answers for military suicide

Source: The Tennessean
Published: Sunday 14 July, 2013

CLARKSVILLE, TENN. — She was a well-liked, exemplary Fort Campbell soldier, a loving mother and wife on a clean, upward career trajectory in the Army that she loved. And she was the last person anyone thought was at risk for suicide.

Right up until the moment she plunged a knife into her own neck.

No one saw it coming – not family, friends, fellow soldiers, health professionals or police, or the Fort Campbell Army officer detailed to conduct the 15-6 Line of Duty investigation into her death.

Hers is one of 17 reports on such investigations recently obtained by Leaf-Chronicle news partner WSMV-Channel 4, Nashville, through Freedom of Information Act requests. The reports shed some much-needed light on a problem of great concern to the communities around Fort Campbell, especially since many military suicides, such as the case cited above, take place outside the post gates.

And the reports illustrate the difficulty of addressing the military suicide problem:

• Some victims were driven perfectionists and model soldiers. Some were anything but. Drugs and alcohol show up in some files and not at all in others. The same goes for financial problems.

• Some had not a hint of relationship issues, or criminal conduct or even minor misconduct, while others rode the razor’s edge of trouble all the way down the chute to oblivion.

• Some gave signs or cried out for help, but many did not, and in too many cases, victims were so good at hiding their problems and their pain that their deaths took those closest to them completely by surprise.

Perhaps surprisingly, none of the soldiers who committed suicide had a diagnosis of post-traumatic stress disorder.

About the reports

Fifteen of the 17 reports available involved units of the 101st Airborne, which covers most of the nearly 30,000 soldiers at the post. Two cases occurred within the much-smaller 5th Special Forces Group. The available reports do not include soldiers who committed suicide while deployed.

Two cases involved women soldiers. The rest were men. That breakdown is close to the actual gender composition of the Army (15.7 percent women).

The reports – spanning a period from Jan. 10, 2011, to Oct. 24, 2012 – are from AR 15-6 investigations, written by Army officers assigned to determine whether a death, disease or injury occurred “in the line of duty” and not as a result of misconduct. That line-of-duty determination has a direct bearing on whether next of kin are eligible for death benefits.

An incomplete answerOne explanation for military suicides has been cited so often that it’s nearly carved in stone: The military is damaged by a dozen years of war, resulting in an epidemic of traumatic brain injuries and PTSD, causing increasing numbers of service members to commit suicide.

The explanation is partly true.

PTSD and TBI are real and massive problems in their own right, with consequences that behavioral health professionals say will be felt by society for a generation after the wars are done.

But according to military-wide figures, slightly more than half (53 percent) of all service members who commit suicide had never deployed.

Of those who had, many were never in combat zones. And of those in combat zones, many didn’t engage in direct combat with the enemy.

According to the Department of Defense Suicide Event Report for 2011, 85 percent of military suicides never experienced direct combat.

Army guidelines no longer stipulate combat service as required for a PTSD diagnosis. But even with that expanded guideline, a majority of military suicides have no corresponding diagnosis of PTSD or TBI to point to as a factor.

And while suicide rates have risen among service members who have deployed, they have also risen among those who have not.

Those who work in suicide prevention or behavioral health say they would love to find a common thread, leading to a “Eureka!” solution. With no common thread, that may not be possible.

By the numbers

One thing that is sure regarding military suicide is that it’s worse today than it was a decade ago, when the military could boast of a low rate compared to the civilian world.

In 2002, the military suicide rate was 10.3 in 100,000. Today, it is nearly equal to the civilian rate, adjusted for comparison to the military’s higher percentage of young white males, at 18 in 100,000. The overall unadjusted numbers nationally are 12 in 100,000.

The spike in military suicides hit a peak in 2012 with 350 – or nearly one a day – combining active-duty, reserve and National Guard figures. The figure exceeded the 295 combat deaths for 2012, causing a public outcry.

In conjunction with a similar trend in suicides of veterans – 22 a day according to the VA’s most recent report –national attention on the issue of suicide has tilted firmly in the direction of the military, almost exclusively.

A statistic that shouldn’t get lost in the focus on military suicides: Civilian suicides nationally are on the rise, especially among Baby Boomer males.

Suicides among civilian men ages 35-64 shot up 50 percent between 1999 and 2010 to an alarming rate of 30 in 100,000, according to a May 2013 Centers for Disease Control report. Rates among women in the same age group, while still relatively low at 7 in 100,000, are up 60 percent in the same period.

Higher expectationsThe focus on the military, in light of state and national figures, is somewhat misplaced, said Scott Ridgway of the Tennessee Suicide Prevention Network.

“It’s easy for the press and the public to look at the number of suicides coming out of the Army and conclude there’s a crisis,” Ridgway said. “But they don’t realize that suicide is just as common, or even more so, in the general population. On average there are more than 900 confirmed suicide deaths in Tennessee each year, and about 35,000 nationwide.

“I think that the media and general public expect fewer suicides in the military because it’s a controlled environment. Fort Campbell has approximately 34,000 service members and 50,000 civilians living on or around the base. If you compare that to any other community in this area with a similar population, you’ll find that the suicide rates these days are running about the same.

“Of course, even one suicide is too many.”

The problem next door

Because of the presence at Fort Campbell of the most deployed division in the Army, the 101st Airborne Division, the post has received a lot more attention in the last few years of reporting on suicide.

Twice in the past few years, the post has seen spikes in suicides – in 2009 and again in 2012 – that were severe enough to result in a “stand-down,” an action taken by a commander temporarily suspending normal operations.

The general meaning of “stand-down” is a relaxation from a posture of readiness. In these cases, however, the action was taken to literally put a stop to a crisis and halt the bleeding.

Fort Campbell announced a series of initiatives combating the problem throughout 2012, such as the placement of embedded behavioral health teams at the brigade level, vastly expanding access to mental health care. However, post officials were reticent to discuss specifics, even as communities outside the post became increasingly alarmed.

Meanwhile, the problem was leaking beyond the post gates anyway, in the form of rumors that made the situation seem worse.

Community concerns

The 2012 suicide spike at Fort Campbell in particular put a spotlight on the post as reaction rose in response to stories circulating in the military community living outside the gates.

Soldiers talk, as do their families, including their children who make up a large part of the enrollment of the Clarksville-Montgomery County School System – in some cases more than 50 percent in certain schools.

During the most recent school year, a West Creek Middle class began their own inquiry into the problem due to the large number of students who were disturbed by the lack of reporting of specifics on a problem they knew of but didn’t understand.

A military suicide triggers an investigationprocess that takes two to eight months to complete, and it is military policy not to discuss cases under investigation. By the time an investigation is complete, the incident has largely been forgotten.

But even if it weren’t, the reports are not made readily public.

Unlike deaths in combat, accidents, or even murder, suicides are not reported by military or civilian authorities, unless the incident is so public, like the Spc. Rico Rawls murder/suicide in March 2012, that it can’t be kept quiet.

A big reason cited by the military is that most families of suicide victims don’t want the cause of death made public.

Last year’s Leaf-Chronicle three-part series on the suicide of Sgt. Justin Junkin was a rare incident in which a soldier’s wife wanted to put a human face on the problem, and it resulted in a community-wide reaction, followed by a concerted effort among social service agencies and religious leaders.

Still, Junkin was only one case, and it aligned fairly well with the public perception of combat-related trauma being the root of military suicides.

What did the other cases have to say?

Coming tomorrow to the Leaf-Chronicle, Suicide in the Ranks Part 2: The individual stories and the triggers that precipitated tragedy, including criminal investigations, and why even a general’s warning couldn’t save a troubled soldier.

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