Editor's note: This is the second in a four-part series exploring the issue of suicide and suicide prevention in the military community.
VICENZA, Italy -- A few months after returning from his second deployment to Afghanistan, a senior noncommissioned officer found himself in trouble.
"I was there physically, but I didn't feel like I was really there. I started to consider whether the world would be better off without me," he said.
While his brigade had lost five Soldiers to rocket and improvised explosive device attacks, the NCO's own deployment was relatively quiet and short, only four months long.
"I had to go downrange to relieve a Soldier who was getting out of the Army. I dropped into a situation downrange that was fluid and foreign," he said.
"The situation wasn't violent, per se. I wasn't in a combat role. In its own way, that adds pressure because I'm in a war zone and I'm carrying a weapon," he continued. "I'm ready at least physically to go to war, but I'm in a noncombat role, and there's a part of me, as a Soldier, that wants to be taking part in that."
His situation was complicated by the fact that he had cross-trained to a new military occupational specialty.
"I was new to my MOS, and I was working at a senior NCO level without senior NCO experience yet. I was effectively doing three jobs in an MOS that I was brand new at. I was acting as the officer, the noncommissioned officer-in-charge and the Soldier," he said. "I was new and I was overwhelmed."
Shortly after the deployment, he was promoted.
"Again, a feeling of inadequacy. There was a part of me that felt like the Army had made a mistake and they promoted the wrong guy. They were going to find out, and I was going to get demoted and get in trouble because I didn't deserve to wear the rank. Looking back, I can see how everything else I'd gone through was adding up and was creating a pressure," he said.
"I felt like an imposter, and I could feel the pressure building. I wasn't sleeping. I'd stay up late for no particular reason … I drank a lot of bourbon," he continued. "It just created this spiral. I thought that my family would be better off without me. I thought that my unit would be better off without me. I was in a dark place and it was getting darker."
While it may have seemed like he was alone in what he was experiencing, Sandra Class, Army Substance Abuse Program manager, said it's not unique.
"I've done unit risk inventories, which are anonymously conducted. These Soldiers know that they can answer brutally honestly. Every time I do one, there are at least two or three Soldiers who have identified having suicidal thoughts or suicide attempts," she said.
His deployment may have contributed to the NCO's depression, but it's not always a risk factor.
"A little more than half the people who attempted or (died by) suicide had no deployment," said Maj. Rebekah Broady, team lead for Embedded Behavioral Health.
Greater contributing factors are loss of relationship, financial issues, occupational stress, and disciplinary or legal problems, she said.
Drug use or overuse of alcohol can also be a risk factor and a warning sign, according to Maj. Osceola Evans, chief of Behavioral Health at U.S. Army Health Center-Vicenza.
"Age correlates with it very strongly, as well. We have a large population of Soldiers who are male between the ages of 18 and 24, away from home for the first time, and they are in a very high-intensity environment. They may get into trouble," he said. "They're isolated and then they may feel like they don't have the support from people within their units, their peer group and their leadership."
When people start to slide into that dark place where they may consider suicide, there are often warning signs.
"Making statements: 'I wish I would die. I wish I would not wake up tomorrow.' Talking about suicide is a big warning sign. Social withdrawal. Is the person isolating themselves or are they pulling away from people? Are they not engaged in the things that they used to enjoy? Is their appearance changing? Are they coming to work looking more disheveled or not as well put-together? Are they not putting forth the same effort or motivation? Are they not doing a whole lot at work? Or are they not really wanting to leave their house?" Broady said.
Class emphasized the importance of listening.
"Even if it seems like a joke, take it seriously," she said. "The window of opportunity is very short. If you miss the opportunity (to help someone), sometimes it's hard to grab it again."
While the key to preventing suicide is seeking help, it's not always easy to do. There has been a history of stigma that the military is working to overcome.
"I think programs like Embedded Behavioral Health and (the Army ACE Suicide Intervention Training) have put a major dent in the stigma," Evans said. "There's still a portion of that out there, but I don't think it's as strong as it once was. I think we're making progress and heading in the right direction."
The EBH program puts a behavioral health provider in each battalion.
"The Soldiers see the provider around the unit. They hear their name. They have a face, so they're a lot more accepting of who that person is. It reduces the stigma. They know where to go," said Broady.
ACE -- Ask, Care, Escort -- trains Soldiers to look out for each other.
"Be aware of how your battle buddy is. Be aware of how they're interacting with people and if there's a significant change, ask them how they're doing. Ask them what's going on. See what you, as a battle buddy, can do to assist them. Take them to Behavioral Health. Take them to a chaplain," Evans said. "To have the knowledge that someone cares about you can be a very strong protective factor with things like suicide."
The senior NCO, whose experience was about four years ago, did feel a stigma, and it was difficult for him to seek help.
"I didn't feel like I could admit what was going on. I didn't feel like I could tell anybody that I was having problems. I would never hold that against any of my Soldiers, and I don't think any of my bosses would have held it against me," he added. "I think the culture is different. It is changing, but there's still a stigma."
For Soldiers who are concerned that seeking help might be reported to their command and have negative repercussions on their career, there are options.
"Any of the chaplains on post have complete confidentiality," said Chaplain (Lt. Col.) James Foster, U.S. Army Garrison Italy chaplain. "They're not going to judge you. They're not going to make you feel like you should know this."
Military Family Life Counselors also maintain complete confidentiality, Class said.
And seeking help doesn't have to mean a lost security clearance or the end of a career, either. As part of an effort to reduce the stigma of seeking help, security clearance questions have been changed.
According to Broady, what investigators are looking for regarding a security clearance is whether the Soldier has good stability, reliability and judgment.
"People are naturally going to face times of depression, anxiety and family trouble in their lives," she said. "The question is, do you have the good judgment to get the help you need to take care of that problem?
"The way I explain it to patients is: you've identified a problem you're having in your life, and you know that you need some help with the problem. So, you come in, you get the help. You get better. Your life gets better. Your family gets better. You don't have an incident at work. You don't get in trouble.
"Those are the things that are going to hurt your career. If you don't take care of the problems in your life, those are going to catch up with you at some point," she continued. "Just like you come in for a broken leg. When that's better, you're returned to duty. You go about the rest of your life. You go about your career and there's not a long-term negative impact."
The importance of seeking help and the lack of negative long-term impact is something that Maj. Gen. Joseph P. Harrington, commanding general and U.S. Army Africa commander can testify to.
"Mental health counseling is critical to our force. In fact, years ago I personally benefited from Army mental health counseling -- it was and has been critical to me and my success. Seeking assistance is a sign of strength, not weakness," he said.
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