Eliminating stigma key to suicide prevention
January 13, 2010
By J.D. Leipold
WASHINGTON (Army News Service, Jan. 13, 2010) -- The Army's director of behavioral health proponent said until the service changes policies that perpetuate stigma, many potentially suicidal Soldiers will avoid seeking help.
Speaking at the departments of Defense and Veterans Affairs Suicide Prevention Conference, Col. Elspeth C. Ritchie explained to the audience that stigma continues to be a recurring problem and while the Army is working on resolving the policies which keep Soldiers from asking for help, the service is not there yet.
Despite the Army's efforts to cease suicides and tackle the issues that cause Soldiers to take their lives, Ritchie said in the first eight days of this month, the Army lost eight active-duty Soldiers and that suicide numbers were increasing.
"We talk so much about reducing stigma, but I don't think we're going to get there until we actually change policies," she said. The data to support her claim was drawn from Fort Carson, Colo., but was "amazingly consistent" with what she had seen first-hand at forts Stewart and Bliss as well as in Iraq, she added.
Ritchie explained while she and her team were in Iraq conducting a study of suicides in theater, when Soldiers in the focus group were asked how they sought help, the answers she received ranged from, "I'm not going to talk to anybody," to "I'm not going to Combat Stress Control."
She also said that older Soldiers care about their careers while younger Soldiers care what their buddies will think about them, so troubled Soldiers simply don't ask or seek help.
Addressing pre-deployment health assessments, post-deployment health reassessments and periodic health assessments as a way to possibly determine Soldiers at risk for suicide, Ritchie said the Army added questions pertaining to post traumatic stress disorder, but none of the assessments were created to serve as suicide screens.
"After every suicide, there's, 'what did he say on his PDHA and PDHRA,'" she said. "The problem with suicide is that in many cases there is something that is triggered in our Soldiers; it's precipitated by some bad event which has nothing to do with how somebody felt six months before."
In the civilian world, suicide screenings by and large are created for psychiatric inpatients. The screenings focus heavily on symptoms of mental disorders, Ritchie said, noting that the Army has not been able to develop a five-question screen that doesn't have too high a level of false positives and false negatives.
"We haven't yet developed the magic buttons, or the magic questions that are going to tell you whether somebody is going to commit suicide in 45 days or 60 days," she said. While the Army is working on how to screen for suicide, the service does have questions in accessions screening which she concedes may or may not make a difference.
"The thing that is good about these is that if somebody is having concerns at the time of the interview, they are seen right away," Ritchie said. "They're seen in all cases by private care and usually by behavioral health care where we've been moving from an appointment weeks later to instantly seeing them on site."
Ritchie also thinks the Army needs to do a better job of getting lessons learned back to commanders, so the service is reviewing whether to bring back psychological autopsies, a practice which ceased in 2001 due to false accusation fallout from the gun turret explosion aboard the USS Iowa.
"One of the challenges we've got right now is that we're doing commander inquiries, 15-6s, line-of-duty investigations, root-cause analysis reports already and we're not stopping suicides, so this is an ongoing tension as to whether getting more data will translate into more effective suicide prevention programs," she said.
Ritchie is also questioning the true worth of getting Soldiers to treatment.
"Unfortunately, our Soldiers who go to get treatment are still committing suicide," she said. "Now about 50 percent of Soldiers who commit suicide have been seen by behavioral health in the year before their deaths and about half of those or 25 percent have been seen in the month before their deaths, so just getting them to treatment isn't making the difference."
"In some cases I fear, it's making things worse," she added. "Soldiers feel if they go to behavioral health they have an additional burden of shame and humiliation that the minute they go, they will labeled by their first sergeant, they're labeled by their colleagues, so I have asked the question: is going to behavioral health a negative step'
"Having said that, I think there are things that we will agree that we can do to increase the awareness by our primary care providers, by our medics in the field to improve our engagement," Ritchie said. "I think that inherently it is still often demoralizing to go to behavioral health where there's still the line of Soldiers across the lawn that keep Soldiers from going in or coming back."