Preventing Suicide among Veterans

By Rebecca A. Clay

A workshop on suicide prevention and mental health promotion at "The Road Home: The National Behavioral Health Conference on Returning Veterans and Their Families" presented some of the military's current strategies for helping veterans cope.

Richard T. McKeon, Ph.D., M.P.H., Special Expert in the Prevention Initiatives and Priority Programs Development Branch at SAMHSA's Center for Mental Health Services (CMHS), moderated the panel of experts.

A New Attitude

The military's attitude toward suicide prevention has changed dramatically, said Col. Robert R. Ireland, M.D., D.Min., Program Director for Mental Health Policy in the Office of the Assistant Secretary for Health at the U.S. Department of Defense.

In the old days, he said, leaders often wouldn't tolerate any sign of weakness among the troops. In contrast, today's leaders make it widely known that they want people to take care of themselves. "If you're a lousy shot, you go out on the range and practice," said Col. Ireland. "If you're having mental health problems, you work on that."

Each of the Nation's armed services—Army, Navy, Marines, and Air Force—has its own suicide prevention program, but they share common elements. "Suicide prevention is more than just getting people together and saying, ‘Don't kill yourselves,' " said Col. Ireland.

His own approach emphasizes informality, part of his effort to make mental health providers more approachable. He writes scripts of hard-times scenarios and asks volunteers to act out the over-the-top tales of failing marriages, troubled kids, and financial woes. By customizing the scripts for each locale, he helps units visualize what trouble might look like and how they should respond.

Educating leaders is also key. The Air Force, for instance, has a "Leader's Guide for Managing Personnel in Distress," which lists common sources of trouble, danger signs, and supportive actions leaders should take. "It's cookbook mental health," said Col. Ireland.

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At the Clinical Level

Lawrence E. Adler, M.D., Director of the Veterans Integrated Service Network 19 Mental Illness Research, Education, and Clinical Center at the U.S. Department of Veterans Affairs, then shifted the discussion to the clinical level.

About 90 percent of people who die from suicide have at least one of the serious mental illnesses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, said Dr. Adler, noting that such disorders often have genetic components. Because psychiatric illnesses significantly increase the chance of suicide, Dr. Adler emphasized, early identification and intervention are critical.

Other conditions, such as AIDS, brain and spinal cord injuries, and sexual trauma, also increase the risk of suicide. So do alcohol and substance abuse. And so does access to weapons. Signs of potential trouble include impulsivity, aggression, accidents, and withdrawal. Clinicians even need to be aware of geographic risk factors, said Dr. Adler.

He pointed out that rural areas and western states have higher suicide rates.

Clinicians should also understand that behaviors that seem illogical may make sense to patients, said Dr. Adler. He described one patient who had a loaded pistol on the seat of his car and a disconcerting habit of avoiding traffic jams by veering into the wrong lane.

"What do I tell him—that we can get him on medication and relaxed?" Dr. Adler asked. The paradox is that in wartime such behavior makes perfect sense for survival. "If this patient stops acting like that, he'll be in grave danger once he goes back."

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