Marjorie Morrison is the author of the recently published "The Inside Battle: Our Military Mental Health Crisis" (Military Psychology Press, $8.99 ebook)
From 2005 to 2010, service members took their own lives at a rate of about one every 36 hours. There are currently more deaths in the military by suicide then killed in combat. Suicides in the US Army increased 80% in 2004 to 2008.
This increase corresponds with the beginning of combat operations in Iraq in 2003. Although everyone is scratching their heads to try to figure out what to do, if the government's solution is to throw more money at for-profit insurance companies in exchange for contracting military mental health programs, I don't think we are going to see those numbers decline anytime soon. Unfortunately, our country is still very reactive with regards to mental health and in my opinion those attitudes need to shift to a more proactive approach.
If we take this high-risk group, our service members, and provide them with preventative interventions, coping skills and social support, I am confident we can make effective progress. It's not only suicide rates that could improve, overall life satisfaction including lower divorce rates, lower substance and alcohol abuse, and higher job performance, are just a some of the benefits of early intervention.
A service member who seeks help has significant barriers to overcome. Almost all of us can look back at a time when we felt depressed. Typically, it isn't until after you get through it that you realize how distressed you were. It's difficult enough to ask for help, but considerably harder when one feels hopeless.
For a service member seeking help, there is another layer they have to deal with. They basically have two options; to see a military provider on the base, VA or within the military system, or seek services from a civilian provider. Both of these options have their own obstacles. The military side can be an oversaturated bureaucratic queue, with risk that getting help may effect your security clearance in addition to the fear of notes being placed in your permanent file. If you go the civilian route, the mental health counselors are often so detached from the military system, not having had access to the necessary training to deal with the unique issues and stressors our military is dealing with.
I don't want to oversimplify the system, there are plenty of overlap programs that are staffed by civilians and targeted to service members. Many of them are very effective, but they also have their limitations. Army Capt Morrison was on hold with a crisis hotline for 45 minutes before taking his own life.
Does the access, availability and confusion of mental health programs account for the root cause in the increase in suicides? Perhaps, but we are going to have to dig a lot deeper to gain a better understanding. Having had the opportunity to work at the Marine Corps 'boot camp" for a year, I watched young boys get transformed into Marines. I gained a richer understanding of how these early values and ideas are developed. We expect them to be emotionally and physically strong and require them to perform instantaneous obedience to orders at all times.
As a psychotherapist, watching this three-month recruit indoctrination process, it became very clear that this was not a population of people that were going to say "hey, I'm feeling a little off I think I need to see a therapist."
While working at MCRD, I was fortunate to have landed in the hands of some incredible Marine leaders. After multiple, lengthy discussions we developed a comprehensive plan to bring mental health services to the Drill Instructors. Consequently, we took all 500 of them (historically known as the "best of the best") the majority having had multiple deployments, and routinely put them through individual and group counseling. We implemented a detailed approach where we helped Marines discover what personally happens to them while under stress. Do you drink too much? Do you socially isolate? Do you become enraged? These were typical questions we asked.
We helped Drill Instructors develop a personal plan to recognize warning signs and specific tools to immediately put into action, before things could spiral out of control. The individual sessions were augmented with groups and that camaraderie piece proved to be equally as important offering unconditional peer support. Between individual meetings and groups, the Drill Instructors were seen every six weeks. Now, whenever I hear the issue of stigma with regards to getting help, I cringe. When every one is doing it from the top down, there is no stigma.
If we compare mental health to the medical field, we can clearly see how taking a preventative stance has significantly improved quality of life. The push to have routine screenings like mammograms, pap smears and colonoscopies have allowed people to discover cancer at a very early stage, ultimately providing them with a much higher survival rate. Screening doesn't prevent cancer but early detection has helped the effectiveness of cancer treatments exponentially. None of these cancers are curable if you find them at a late stage. We selectively screen populations that are higher risk for the disease. We don't recommend mammograms to women at 25 or 80, we suggest them if you're over 40, the target breast cancer group. In the same regard to our military, we need to recognize they are an at-risk population and we need to employ a proactive approach.
If a concern is identified during the individual or group sessions, the counselor can facilitate appropriate community and on-base resources for further assistance. When working with the Drill Instructors I had specific referrals for just about any issue. If they reported having marital problems, it wasn't uncommon for me to call a marriage counselor with him in the room to schedule the first appointment. Talking and sorting things out before they become major problems is beneficial from every angle.
It's not all grim and there has been some improvement. Pre and post deployment questionnaires are routinely administered now and in-theater suicide briefs have become mandatory. It's not personalized and can be considered by service members as a "check in the box," but it's a step in the right direction.
There has also been movement by advocates like Senator Murray and her Mental Health ACCESS Act of 2012 to analyze and improve services. Unfortunately, there is often a huge disconnect between those that are designing the programs and the folks on the ground that are receiving them. Perhaps we should be looking at institutions like the Israeli Defense Force, who actively engage in proactive counseling and don't have our suicide issues. Until the conversation switches toward prevention, I'm not optimistic. The military has a saying, "complacency kills."
With over a million men and women set to return home from the Middle East and third of them expected to be plagued with combat stress, now is the time to change the military's mental healthcare system.
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