FORT MEADE, Md. -- While suicides among active-duty Soldiers reached their highest levels in a decade last year, Army leaders have already executed measures to bring those numbers down.
The Army released a recent report that shows suicides among Soldiers surpassed 300 in 2018, or about 30.8 suicides per 100,000 people. Deaths by suicide among National Guard members continue to remain the highest percentage among the Army's components, while Reserve Soldiers showed a slight decrease in suicides.
White males aged 20-29 between the grades of private first class to staff sergeant rank as the highest demographic for suicides. According to the report, a combination of relationship issues, financial troubles, work-related problems, pain-related and behavioral problems factored into the suicides.
Suicide prevention falls in line with the new Army Chief of Staff Gen. James C. McConville's first priority -- people, said Dr. James A. Helis, director of the SHARP, Ready and Resilient Directorate.
The Army's G-1 staff has met with the CSA and the other Army senior leaders to discuss suicide prevention and to offer ideas and initiatives to reduce the rate of incidents in formations.
PILOT PROGRAMS
To get at this issue, the Army is testing two pilot programs. The first is a 12-month prevention program that will launch this fall at two Texas installations, Fort Bliss and Fort Hood, and also at Kentucky's Fort Campbell.
In addition to watching the fluctuation in the number of suicides, the test will closely examine the factors that led to the suicides within each participating unit. The Army will evaluate the program's effectiveness in the fall of 2020.
"We will also be looking at mainly…the risk profile of the unit and risk factors within the organizations. Did the risk factors decline over time?" said Helis.
The Army is testing another initiative: a tool called the R4, or the Behavioral Health Readiness and Risk Reduction Review Tool. The R4, currently being piloted over three phases with the 4th Infantry Division at Fort Carson, Colorado, and the 82nd Airborne Division at Fort Bragg, North Carolina, launched last spring. The one-year test trains commanders and first-line leaders on how to conduct risk assessments and have open discussions with Soldiers on potential behavioral health issues and/or risk indicators.
Another leader visibility tool the Army is providing leaders and Soldiers is the Commander's Risk Reduction Dashboard Increment 2, an update of the original version of the CRRD that was fielded beginning in 2017.
Increment 2 expands commanders' visibility from 16 factors to up to 40 and provides company and battalion commanders with individual Soldier risk history such as driving under the influence, Uniform Code of Military Justice violations, financial issues, and domestic problems. The tool provides brigade commanders with aggregate unit data, Helis said.
The SR2 Directorate also created and updated additional resources for Soldiers and leaders -- the Soldier Self-Assessment Tool, and the Behavioral Health Pulse. In order to help Soldiers help themselves, the Army developed the new SSAT, a 15-minute survey that provides Soldiers an assessment of their psychological, family, social, spiritual, and physical fitness. The SSAT is a streamlined version of the Global Assessment Tool, or GAT, survey that the Army has been using to measure Soldiers' wellbeing since 2009.
The revamped BH Pulse provides brigade, battalion commanders and their behavioral health officers a snapshot assessment of behavioral health across their formations. Data captured through this tool includes suicidality, depression, post-traumatic stress disorder, access to care, barriers to care, social relationships and command climate.
"The information from these tools do not come back to commanders individually," said Helis. "It's aggregated to identify to the commanders some of the issues that may be going on in the command and the awareness and some of the risk factors that may be present in the command climate.
Helis said the visibility tools "should help commanders better understand their formations and better design trainings and interventions."
REDOUBLING EFFORTS
To facilitate access to care, the Army has embedded behavioral health teams in operational, or deployable, units. These teams are located in close proximity to where Soldiers live and work, such as close to Soldiers' barracks or battalion headquarters, to help Soldiers experiencing behavioral health issues such as suicidal ideation gain easier access to care.
"A vital component of the EBH program is alignment of providers to units," said Lt. Col. Chester Jean, deputy chief of behavioral health at the Office of The Surgeon General.
"We see unit leadership as vital in early identification of Soldiers who may be suicidal or have suicidal thoughts and facilitating access to care," Helis said.
In addition to medical care, SR2 is also providing critical resources and training such as embedded performance enhancement experts -- to enhance the resilience of Soldiers. Resilience is a significant protective factor in prevention of suicide, he said. PEs are available to teach Soldiers how to develop resilience to overcome problems both on duty and at home.
"We've learned that there is no single solution that is going to eliminate death by suicide," Helis said. "It's a complex challenge and we're redoubling our efforts."
RARE BUT SERIOUS PROBLEM
Warning signs often can be unique to the individual and the circumstances differ from case to case. However, many suicide cases have common warning signals to include individuals feeling isolated, helpless, hopeless, or a burden to others, Jean said. While suicides remain relatively rare events, studies at this time are unable to explain causes for the variance in numbers from year to year.
"The reason for an increase -- that is not something that we're able to define even though we know the risk factors," said Jean, who is an active-duty psychiatrist.
"To be honest, we don't know," Helis said. "That's pretty straightforward. We don't know. Suicides are individual events and while there are commonly-identified risk factors that go with suicide, what triggers an individual to go from being at risk to actually attempting or dying by suicide, we don't fully understand."
National Guard members often have life circumstances that differ from active-duty Soldiers, as they could have dual military and civilian careers, said Lt. Col Rob James, an analyst with the SR2 Directorate.
While the Army has emphasized readiness for its Soldiers in recent years, a heavy operations tempo and deployments are not seen as contributing factors.
"The majority of Soldiers who died by suicide have zero or one deployments behind them," Helis said.
SEEKING HELP
Soldiers who have thoughts of suicide have a wealth of available resources they can take advantage of, both anonymously and through their unit. Helis said Army leaders also encourage the chain of command and bystanders to intervene.
A common fear Soldiers have stems from the possibility of negatively impacting their career by seeking help or disclosing their feelings. Reaching out for help can help Soldiers refocus on the benefits of improved functioning and alleviate those fears, Jean said.
Helis added Soldiers may also fear that seeking help shows weakness. Army leaders believe it's the opposite.
"Recognizing when you have a challenge in your life and that you need help is a sign of strength; it's a sign of self-awareness," Helis said.
Jean, who has treated Soldiers who have overcome thoughts of suicide, said Soldiers can seek help through their first sergeant, unit chaplain or by seeking counseling at their unit or installation behavioral health clinic.
Soldiers also can seek help anonymously by calling the Military Crisis Line or the National Suicide Prevention Lifeline at 1-800-273-8255. Information about contacting the lifeline from overseas locations can be found at: https://www.veteranscrisisline.net/get-help/military-crisis-line.
"Many Soldiers are working through their personal challenges--such as feelings of helplessness and hopelessness -- with providers or individually," Jean said. "Counselors, through a series of sessions, can help those suffering think through their distressing thoughts and emotions, and create action plans to help them cope.
"Through counseling, Soldiers can gain an increase in perspective and objectivity with regard to how they view their situation," Jean said.
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