How to save a life
August 25, 2011
It would have been so easy.
All Staff Sgt. Tiffany Skelton had to do was take a few extra pills--she was on Zoloft, Paxil and three others--and she would drift off into a peaceful, permanent sleep. Or she could nick her wrists with one of the swords she had collected in Iraq, and let her lifeblood drain away, taking with it all of the worries and pain she had carried for so long.
Skelton had it all planned, down to who would pick up her son. He would probably be better off anyway, she reasoned. How many nights had 18-month-old Kenyen taken care of her as she lay on the couch, too depressed and overwhelmed to move? He covered her with a blanket, and brought her dinner from whatever he could reach in the refrigerator. Then his day care teacher called: Did Skelton know that he no longer smiled or wanted to play? That he was biting?
"I just couldn't take it anymore," Skelton said. "I had made my decision. I was going to die the next day."
Skelton's road to suicide started long before that June day in 2009, when she was an emotionally abused little girl in Georgia. She wanted to serve, but more than that, she wanted to escape her mother's death, and relatives who only cared if Skelton was around to cook for drunken uncles in the middle of the night. An automated logistics specialist, Skelton was excited to escape all the way to Iraq in 2003, until, that is, she realized a new nightmare awaited her.
Skelton's Reserve unit was assigned to the middle of the Sunni Triangle (between Baghdad, Ramadi and Tikrit), otherwise known as the "Triangle of Death." They were soon in the cross hairs of the fast-growing insurgency, facing multiple mortar and rocket attacks a day.
It was horrible, Skelton remembered. "I've seen people die in front of my eyes." She also suffered white phosphorous burns from one of the mortars, and she often slept with both a loaded M-16 and her gas mask.
Worse, to Skelton, the unit's officers and noncommissioned officers didn't seem to care. She felt angry and betrayed, and she didn't handle the stress well. On separate occasions, Skelton "lit into" both her company commander and a senior NCO, receiving first an Article 15, and later losing a rank and a week's pay for her conduct.
Part of the problem was that as their redeployment date grew closer and Skelton's fellow Soldiers talked excitedly of home--of parents, spouses, new babies--a knot started to grow in Skelton's stomach. She had nothing to go back to but family problems, which she had left to fester for a year, and now she had added the salt of war to her open, oozing wounds.
"I didn't have a home. All of that stuff that I'd been harboring started to boil…I hadn't let it out yet," she remembered.
But after Kenyen was born in 2007, Skelton became determined to make a better life for her son. She overcame the black marks on her record with hard work and high PT scores, and was selected for a position at Headquarters and Headquarters Company, Human Resources Command-St. Louis because of her potential, according to her former company commander, Maj. Daphne Davis. Skelton graduated in the top one-percent of her Basic Noncommissioned Officer Course; she studied for and was inducted into the Sergeant Audie Murphy Club, which is basically an NCO honor society; she tried to go to school; she went to church events almost every night. She was exhausted. It wasn't long before she had collapsed on the couch, barely able to move, let alone continue the busy schedule that had disguised the hole in her heart.
No one had ever taught Skelton how to manage money, and she fell deep in debt after a friend stole $25,000 during her deployment, and Kenyen's father stopped paying child support. Skelton was months behind on car payments, and she couldn't get a security clearance--a requirement for her job at HRC. She was terrified she would lose her job and be unable to feed Kenyen.
In addition to her financial problems, her work began to suffer and Skelton had several unhealthy relationships--all of which are major warning signs for suicide, explained Davis, a Reservist who is also a licensed clinical social worker. Davis added that because Skelton was a single parent, she was under extra stress and especially vulnerable, but that Skelton's mood swings were the most disturbing. Some days Skelton would be happy, others angry and still others, quiet and withdrawn. No one knew what to expect.
"I thought I wasn't good enough for anything," Skelton recalled. "My self-esteem was shot. I stayed in a depressive mood. It would be beautiful outside, but I would close everything and it would be dark. I would stutter. I would forget things. I was mad one (minute) and I would cry the next."
"It just didn't seem normal," Skelton's noncommissioned officer in charge, now-Master Sgt. Julio A. Vejar, said of her behavior. "When someone's attitude changes very drastically, you know something's not right. Too often we as NCOs or leaders are very quick to…go to the sword instead of counseling. Take the time. There's always a reason for something.'"
Convinced something was seriously wrong, Vejar, Davis, 1st Sgt. Michael Gaston and Capt. Edgar Borgella, the company executive officer, sat Skelton down and told her they cared, that they wanted to help her. It worked eventually. Skelton started to open up, started to confide the painful details of her abusive childhood and traumatic deployment, first to a doctor during her periodic health assessment and then to Davis.
"I can't do it anymore," she told Davis after crying for two hours. "I feel the pressure. Everything feels like it's falling apart." Davis put her in touch with Military OneSource (www.militaryone-source.com, 1-800-342-9647), which in turn referred Skelton to a psychiatrist. She was quickly diagnosed with severe post-traumatic stress disorder, severe anxiety disorder and severe depression, and put on five separate medications. (She was eventually diagnosed with bipolar type II disorder as well.)
"But it didn't matter," Skelton said. "It didn't help the hurt." It was the hurt she wanted to end--forever--and she started playing with her swords. Around the same time, however, HRC started its Army suicide prevention training and after one of the first sessions, another NCO went to Vejar: Skelton's emotional withdrawal, erratic behavior, mood swings and financial and work problems were all signs they'd just been told to watch for, and he was concerned.
"I decided not to say anything to her," remembered Vejar. "I just reiterated to the entire staff, 'Hey if you guys have anything you want talk about, let us know.'
"I had a personal experience when I was a young Soldier, and I feel like I failed somebody. I didn't have the tools or skills to assist that person," he later explained, adding that Soldier is dead and members of his own Family have committed suicide, so he was determined to keep Skelton from the same fate.
Soon after, upset because Mommy was upset, Kenyen bit someone at day care and came home crying for the third or fourth time. Skelton was devastated. Her son didn't deserve to suffer because of her. He deserved so much more. He deserved a better mother.
The next morning, June 13, 2009, she told Vejar, "If I leave here today, I'm not coming back" in the middle of a normal conversation.
To Skelton, it was not a cry for help. She was only stating what to her was obvious, but Vejar froze as the full meaning of her words hit him.
Was she going to hurt Kenyen? he asked.
No, of course not.
Was she going to hurt herself?
That question, Skelton explained, probably saved her life. "You never ask anyone 'Do you want to commit suicide?'" she said. "They're going to tell you 'No.' If you ask, 'Do you feel like hurting yourself?' that's a different question. A person who's suicidal isn't thinking 'I want to commit suicide.' They're thinking 'I want this pain to end. I don't like the way I feel right now.' They don't want to commit suicide."
Vejar ordered her to stay where he could see her as discreetly as he could--nobody made a spectacle out of her or "took her shoelaces," marveled Skelton--while he called Davis, who was on leave. She dropped everything to help.
Skelton's biggest worry was her career: Could she still be a Soldier? Yes, of course, Davis and Vejar assured her. This was a private matter--it wouldn't become command gossip and it wouldn't affect her career. In fact, she had shown a lot of strength and courage by speaking up and they were proud of her. They were going to get her help.
Davis got in her car and tailed Skelton for the hour drive to her psychiatrist's office. "And when I say she followed my car…every time my car moved, her car moved. I can still remember thinking 'If I let go of this wheel, it would be so much easier. Nobody would have to worry about me anymore,'" Skelton said, adding that only the sight of her commander in the rearview mirror stopped her.
Together, they arranged for Kenyen to stay with a friend and found an outpatient program at a nearby hospital. Davis made the hospital Skelton's place of duty for the next six weeks, so there would be no leave forms, no paperwork beyond what TRICARE required. The only problem was that it was the middle of the week and the program didn't start until the following Monday.
So Davis followed Skelton to her house, where she collected Skelton's medications and confiscated her weapons, even her butter knives. That was what had alarmed her most, Davis later explained--that Skelton knew exactly how she would kill herself.
"If there's a plan in place, that's very serious," Davis said. "If a person (says) 'Sometimes I think about it,' although that's serious, it's not quite to the next step. So when I asked her 'What exactly are you thinking about doing?' and she said hurting herself with one of her knives, that's a plan. It's scary."
Skelton learned a lot about herself during her recovery, about how to handle her emotions and different ways to cope. She realized that she couldn't always control what happened to her, only how she responded to it.
But she also learned a lot about the Army. Although Davis and Vejar had repeatedly told her everything would be OK, a part of her didn't believe them until she turned on C-Span to find Army Vice Chief of Staff Gen. Peter W. Chiarelli testifying before Congress about the climbing Army suicide rate. He urged Soldiers to get help.
It was a turning point for Skelton. He changed her life, she said. "It was OK. There was still life as a Soldier after being diagnosed. I listened, mesmerized, for like an hour. I still have that script. When they came out with the Comprehensive Soldier Fitness Program, I was jumping for joy, because somebody finally understood that we were struggling."
Equally important, Skelton still felt like part of a team. There wasn't a day that either Davis, Vejar, her first sergeant or the XO didn't call to check on her, they took her out to dinner and Vejar answered every time Skelton called at 3:00 a.m., desperate to talk to someone. They all remain in touch today.
"There's no checklist that says 'She's at the doctor. I don't have to worry any more,'" Davis said. "No. Caring does not go away."
The final portion of the Army suicide prevention training at HRC was scheduled soon after Skelton's return to work, and Davis worried about her reaction to the emotional training scenarios, which included a Soldier suicide. It also didn't help when some of the Soldiers, and even NCOs, in the audience laughed at the suicide as though it were a video game.
It hurt, Skelton said, but "I was so grateful, forever indebted, to the staff where I worked. They sat around me. They flanked me. I can remember thinking if somebody else in that audience needed help, they wouldn't want to tell anybody based on what they heard. It's sad for me to say that I was lucky, but I am."
"My civilian education and background helped me to know exactly what to do," Davis said. "But for my staff…the (Army) suicide prevention training…assisted a lot with giving Soldiers the courage to ask the question or to at least…tell someone else." If necessary, Davis continued, a commander can and should take a Soldier aside and say "You have an appointment with the chaplain," or "You have an appointment with behavioral health. Nobody knows but us."
The key is to know your Soldiers, Vejar added. "(Skelton's) a success story, but she doesn't have to be the only one. There's different ways that people ask for help. We have to pay attention to our buddies, to our Soldiers, even to our leaders. It's not bad to ask, 'How are you doing today? Are you OK? Do you want to talk?' It doesn't take much. It's not going to cost you anything. If somebody tells you 'Help,' get them help.
"I can tell you that from personal experience…a Soldier needed to talk…and I didn't know how to deal with it…. I didn't take him seriously. If you don't take your Soldier seriously…you're going to risk…going to bed sometimes and not being able to sleep." He's proud of Skelton, Vejar continued--proud, and grateful he too got a second chance.
Today, Skelton touches base with a therapist about once a week and continues to take one of her five medications, which she'll probably need for life. She's OK with that though, because she's happy and she's successful. She's newly married to an Army sergeant and taking her husband's name (Saffold), but most importantly, Kenyen is a happy, active 3-year-old.
A quartermaster career manager, Skelton recently passed the promotion board for sergeant first class. (At press time, she had expected to pin on her new rank sometime over the summer.) She's in school for medical massage therapy with a physical therapy track, and hopes to specialize in treating post-traumatic stress patients one day.
Her story is featured on the new Army Shoulder to Shoulder suicide prevention video. (Look for the video under Training Videos at http://www.armyg1.army.mil/hr/suicide/training.asp.) She's sharing it, she said, because she's a strong Soldier, because no one would ever suspect she's been through such challenges.
"Don't be afraid to talk about what's wrong," she said. "Get the help that you need. You can return to duty and…become stronger than ever because that's one thing that's not weighing you down anymore."
Editor's Note: For an Army psychiatrist's take on suicide, post-traumatic stress disorder and other behavioral health issues, see the May issue of Soldiers magazine: http://www.army.mil/article/55474/protecting-the-mental-health-of-the-force/.
A SOLDIER MAY NEED HELP IF:
He talks/hints about committing suicide or hurting someone else.
She plans to acquire the means to kill herself (weapons, pills, etc).
He expresses a desire to die and/or has an obsession with death.
She has a history of previous suicide attempts or a family history of suicide or violence.
He was diagnosed with a serious medical condition or recently experienced a significant loss such as the death of a loved one.
She abuses alcohol and other substances, or has a history of depression or other mental illnesses.
He has been exposed to severe, prolonged and/or unmanageable stress.
She has an overpowering sense of powerlessness, helplessness and hopelessness.
He begins to give away his possessions and finalize his personal affairs.
She withdraws from friends and activities.
His behavior becomes bizarre, unusual or otherwise out of character.
She has relationship problems.
He has financial problems.
She has work-related problems, or experiences other career, academic or personal setbacks, including civilian job loss if she is in the Guard or Reserve.
He is undergoing a major life transition such as retirement or military discharge.
She is facing disciplinary or legal action.
SUICIDE RISK IS HIGHEST WHEN:
The Soldier sees no way out and fears things may get worse.
His predominant emotions are hopelessness and helplessness.
She can only see the negative things in her life.
His judgment is impaired by the use of alcohol or other substances.
(The above risk factors are from the Army Public Health Command's "Suicide Prevention: Warning Signs & Risk Factors" tip card, which can be viewed or ordered at https://usaphcapps.amedd.army.mil/HIOShoppingCart/viewItem.aspx?id=114.)
WHERE TO TURN FOR HELP
National Suicide Prevention Lifeline
Wounded Soldier and Family Hotline
Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury
Army Suicide Prevention Program
Army Behavioral Health