With understandable urgency, Secretary of Defense Leon Panetta has made suicide one of his top priorities, instructing commanders at all levels to feel acutely accountable for it. The numbers are startling. On average one active duty soldier is killing himself each day, twice the number of combat deaths and twice the civilian rate. Suicides have jumped dramatically since 2005 and increased by 18% in just the last year. The DOD and VA are groping for explanations and plans of action -- clearly, just commanding the commanders to prevent suicide can't possibly do very much. And, sadly, psychiatry has no ready or certain answers, no sure way to predict or prevent suicide. Research in this area has huge methodological problems and is unlikely to bear any low hanging fruit. So, we may have to rely on obvious, common sense suggestions:
1) Stop over-deploying and over-extending our soldiers -- withdraw troops from all combat zones as soon, and as fully, as possible. Our continued presence seems to make bad situations worse and entails enormous human and financial costs. It is long past time to cut our losses in these lost causes.
2) Stop the rampant over-medication of our troops with psychotropic and pain drugs. An astonishing 8% of military personnel (110,000 soldiers) are taking a psychotropic medication, often two or more different kinds in dangerous polypharmacy combinations. Abuse of prescription drugs is now a bigger problem than abuse of illegal drugs. Simple quality control of physician prescribing habits and pharmacy distribution systems could greatly improve this important contributor to suicide and accidental over-dose.
3) Train commanders to combat the cluster effect. Suicide is contagious- each occurrence makes suicide seem a more reasonable choice for imitators. Almost 40% of military personnel know someone who has killed himself. Command should emphasize that suicidal feelings are common and that getting help for them is brave and soldierly; but that actually killing yourself is selfish, unnecessary, uncool, and places a grave and lasting burden on buddies, family, and country.
4) Guarantee jobs for vets for the first two years after military service- either in the government or the private sector. Financial distress and unemployment are major contributors to suicide. Our discharged troops often have poor future prospects and face stigma on the job market. Many may need a transitional assist to avoid the frustration and dependency of joblessness.
5) Provide extensive and readily available mental health services for identifying and treating depression and PTSD -- two major risk factors for suicide. Treat these more with cognitive/behavior therapy, less with drugs.
6) Provide extensive and readily available substance abuse programs to help alleviate this other major risk factor for suicide.
7) Target special help for soldiers who have gotten into trouble and face administrative or criminal charges -- another risk factor for suicide.
8) Provide much more support for families and readily available family therapy to reduce domestic conflict and try to salvage marriages on the rocks.
9) Appropriate gun control laws for all would help reduce the risks of suicide and violence for vets.
10) Avoid future wars of choice. We have fought three large scale, unwinnable wars in fifty years- coming out weaker, poorer, less respected, less feared, no safer, and with generations of warriors who were spiritually and physically wounded. Will we never learn from the past?
The suicide problem is just the very tip of a much larger iceberg. That one active duty soldier per day is desperate enough to kill himself speaks volumes of the less obvious, but significant, distress experienced by many other soldiers and veterans. We have a responsibility to stop over-extending ourselves in poorly chosen 'wars of choice' and to pick up the pieces of the harms already done.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.