FORT SILL, Okla. (April 7, 2016) -- Maj. Gen. John Rossi carries a card in his wallet with 10 photographs on it. Each photo is of a Soldier who died during his tenure as the commanding general of the Fires Center of Excellence and Fort Sill. Four of those deaths were by suicide.
At the Suicide Prevention Summit at Snow Hall, March 30, Fort Sill leaders grappled with the problem of Soldier suicides. Rossi began the summit by reading reports of several recent attempted suicides of Soldiers, and said that he gets similar reports about four times a week. Most contemplating ending their lives are in basic combat training, he said as he showed the card he keeps in his wallet to the assembly.
"We are ultimately responsible for Soldiers both on and off duty," he said.
In her introduction, Dea Schmidt, Fort Sill's suicide prevention manager, said suicide "is a compelling, complex issue that only becomes worse if we bury it or explain it away."
William Kappel, supervisory social worker at the Warrior Transition Unit, Reynolds Army Community Hospital, directed his talk to leaders who need to recognize and respond to any threat of self-harm.
"Leadership is about knowing your Soldiers," he said. "If you don't know your Soldiers, you can't help prevent what we're talking about today. As we right-size the force, we are asking our Soldiers to do more and more with less and less."
Not only does that put added stress on the individual, it makes it harder for leaders to find the time to connect.
He said young Soldiers are especially vulnerable because they don't have the life experience or maturity to deal with issues such as divorce, financial troubles or problems at work. Promoting younger Soldiers into positions of responsibility may compound the problem.
"The 25- to 35-year-old E5s to E9s had the highest suicide rate last year," he said of statistics comparing military to civilian suicide rates. "The jump from enlisted to NCO is a big jump."
Kappel asked the assembly, "Are you trained enough to see and hear increased stressors and how this is impacting the Soldier? We need to have a holistic approach. We need to look at the culture of the military. We need to look at leaders. We need to take a look at the individual."
He said Soldier development is more than teaching job skills. It's also teaching coping and problem-solving skills and helping Soldiers develop positive life experiences. Soldiers may avoid asking for help because they don't want to be seen as weak, or have others filling in when they're not at work.
"We have this vulnerable population, and we have to encourage them to seek help," stressed Kappel. "Critical thinking, stress management and relationship skills. How do we imbed this in the training regimen as we develop Soldiers over the course of their careers?"
Eliminating the stigma of seeking help for mental health issues involves leadership as well. When a Soldier hears, "What do you mean you're not going on this training exercise? You're just using this stuff as an excuse," it sends a negative message. "We need to watch how we address stigma," he said. "If we can't foster trust, they will never come to us and talk to us."
Knowing the signs of impending trouble is critical to intervening in a possible suicide attempt.
"Depression is present in 70 to 80 percent of suicides," he said. "One of the strong features of depression is ambivalence: one foot in the 'I want to live' door, and one foot in the 'I want to die' door."
The second sign to watch for is some type of injury or stress financial, relationship, work, academic.
"Something that causes an overload," he said. "It's not so much that the stressors are there, but it's how those stressors impact the individual. And, if you don't know the individual, then you don't know what that impact is.
The third thing I look for is drugs and alcohol." Not only are they a quick escape, they also inhibit good judgment and can make it more likely for someone to act on suicidal thoughts, said Kappel.
He added there are different levels of suicidal actions. Thinking about killing oneself is different from the normal thoughts people have about death, and indicates a state of mind that shouldn't be ignored. Gestures and attempts to end one's life may look the same, but the intent of a gesture is to send a message. The intent of a suicide attempt usually isn't to succeed in killing oneself. Kappel said sometimes someone acting out a gesture may die accidentally.
"I've seen lots of kids try to hang themselves by their boot strings. Their intent was not to die, but to get the system to give them what they wanted." He said he's often had someone in the hospital recovering from a failed suicide attempt tell him they really didn't want to die.
"Most people contemplating suicide believe suicide is a solution to a problem in their life," said Kappel. "You (as intervener) don't have to have all the right answers. You simply have to know who's vulnerable and bring them to the appropriate resources: the chain of command, the chaplain, behavioral health, the hospital. They will all eventually get funneled to our behavioral health team."
Many times, family members or friends of someone who attempted suicide may blame themselves for missing the signs or not acting on them. Reviewing fatalities in a command setting should be seen as an opportunity to examine systemic weaknesses, but with the wrong approach it becomes "a witch hunt."
The Health Insurance Portability and Accountabil-ity Act (HIPPA) regulations prevent medical facilities off post from reporting suicidal tendencies to a Soldier's command due to privacy concerns. That's one of the vulnerabilities that needs input from legal staff, he said, in order to come up with exceptions to that restriction if they are to mitigate suicides.
He said of the 2,500 mental health contacts per month seen by behavioral health staff, about five to 10 people a day are considering suicide.
"We probably psychiatrically hospitalize three to five Soldiers a week," he said.
Another stumbling block is weapons of suicidal Soldiers off-post cannot be legally confiscated due to the Second Amendment, said Kappel. "Now you can encourage that Soldier to give it up, you can ask his spouse to go get it, you can ask a friend to take it, but you as a command team can't walk in there and say, 'you're suicidal, you're dangerous, you have compromised judgment and I want that weapon.'"
Although women at-tempt suicide three times more often than men, 75 percent of men who attempt it die because they use more aggressive methods such as firearms and asphyxiation, compared to women's use of pills and cutting.
"Suicide is the ninth or 10th leading cause of death in America," he said, "but it's the second leading cause of death in 17 to 24 year olds."
For military families, the uncertainties of being deployed or transferred, the stresses of starting over in a new school and post, and low pay make young male Soldiers particularly vulnerable.
Suicide survivors spoke at the summit. Discussions explored intervention techniques and other resources.
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