Military Suicides, Stigma and the Elephant in the Room

The cover of this week's Time magazine is dramatic: "One a Day." Every day one military service member commits suicide. The stories are heart wrenching. The two keys that emerge are overcoming stigma and adequate treatment resources. A new bill authored by Senator Patty Murray, the Mental Health Access Act of 2012, recommends use of peer-to-peer counseling to address this problem.

Nothing can prevent someone intent on killing themselves from doing so. Mental health treatment is not the new silver bullet and psychotherapists are not magicians. The epidemic of military and veteran suicides requires action on multiple levels. But our strongest ally in this fight is hidden in plain sight - the most powerful motivator for service members and veterans - their love for, and the love of, their buddies. We need to mobilize it immediately.

Not everyone needs therapy. For many, robust peer support networks, integrative wellness practices, psycho-education, and vigorous recreation in the great outdoors serve quite well. Some need psychological treatment and they should get the best possible, with user-friendly access; no question. Some participants at Coming Home Project retreats ask us about what they can do to help themselves, their families, their kids. They ask for resources and referrals, and we provide them. They're more likely to listen to our recommendations. And more likely to follow through when their fears about being crazy, "different" from all their buddies, have receded and become normalized. Stigma loses its grip in a non-judgmental, accepting, safe, peer support-based culture, supported by therapists and veterans. We've seen it time and time again.

Suicide prevention does not equate with mental health treatment. And mental health does not equate with psychiatric treatment, be it psychological counseling, medications, whatever. Big top down PR campaigns don't suffice. Big expensive unproven trickle down train-the-trainer approaches have not worked. There is a stigma nationwide about getting psychological help, not just in the military. There is also stigma when it comes to resolving international problems - what it means to be strong politically. So reducing stigma among service members and veterans confronts these two formidable societal obstacles.

I won't address here the huge question of what it means to really be strong and powerful: politically, economically, militarily, emotionally, socially, spiritually: as a warrior, a nation, a man or a woman. What mythic narratives inform our views, and just how they are working for us individually and collectively.

Rather, I want to tackle the elephant in the room. The Assistant Commandant of the Marine Corps and a group of general officers is exploring the value of unit cohesion in suicide prevention. I've written in earlier blogs about community as the civilian version of unit cohesion. Why then is there so little attention played to the documented value of social supports in general, and peer support and community-building for transitioning service members, veterans and their families in particular? Understand that I'm not equating peer support with peer to peer counseling which still requires one to self-define as "having a problem."

How ironic would it be if "mental health treatment," itself traditionally associated with stigma, became the new strong, tough-minded solution? And established evidence-based peer support, preventive, early intervention, and other integrative approaches became the weak, soft-minded, second-class alternative? Reducing stigma requires changing a culture. Peer support-driven integrative programs such as the Coming Home Project create a non-judgmental, unconditionally accepting culture, a community that is infused by and transmits these values.

Psychological treatment is not to be feared or avoided; neither is it the holy grail for suicide prevention. I applaud the Marines for going old school and having the courage to revisit unit cohesion. Our data show that active duty service members and military families can also benefit from such programs, held off base. Not to mention those tens of thousands transitioning back to civilian life and veterans. Troops come home to a community, not a set of isolated services. It's up to all of us to create this connective tissue: a safe place to connect, heal and learn.