Excess prescription drug use and a “flawed” post-deployment mental health screening process are among the factors fueling an increase in suicides among military service members, a new report by the Center for a New American Security [CNAS] says.
“America is losing its battle against suicide by veterans and service members. And, as more troops return from deployment, the risk will only grow,” the comprehensive report by the influential military policy group concludes. “The time has come to fight this threat more effectively and with greater urgency.”
The report cites an increasing number of suicides in the military, including a “record-high” number of 33 active and reserve component service members who took their own lives in July 2011. The VA estimates that a veteran dies by suicide every 80 minutes, while other statistics suggest that former service members represent about 20 percent of all suicides in the U.S.
While the report credits the military and the VA for taking a number of steps to stem suicides, it also finds fault with myriad policies and calls for improvements in mental health screening and treatment. It raps the “prevailing wisdom” in the military that suicides are not linked directly to deployments to war.
While an estimated 31 percent of Army suicides are associated with factors that can be traced back prior to enlistment, recent reports have shown that soldiers who have deployed are more likely to die by suicide.
“Data have long indicated definitive links between suicide and injuries suffered during deployment,” the report says. “Individuals with traumatic brain injury (TBI), for instance, are 1.5 times more likely than healthy individuals to die from suicide.” Additional factors that heighten risk include PTSD symptoms such as depression, anxiety, sleep deprivation and substance abuse. “These factors are…widely associated with deployment experience in Afghanistan and Iraq,” CNAS says.
On prescription drugs, the report cites surveys showing that about 14 percent of the Army population is currently prescribed an opiate medication. Forty-five percent of accidental or undetermined Army deaths from 2006 to 2009 were caused by drug or alcohol toxicity, and nearly 30 percent of Army suicides between 2005 and 2010 included drug or alcohol use.
“Misuse of prescription medication is another obstacle to addressing the problem of military suicide,” the report says. It recommends that the military collect and destroy excess medication given out to troops, to prevent hoarding and overuse.
The report also finds flaws in the mental-health screening process following deployment, in which troops are asked to fill out a health-assessment form that asks questions about their physical and psychological status. A 2008 study found that when Army soldiers completed an anonymous survey, their reported rates of depression, PTSD, suicidal thoughts and interest in receiving care were two to four times higher than the responses on the official forms.
The CNAS researchers said that many returning troops lie—and are encouraged to lie—for fear that if they admit to mental health problems, they will not be allowed to go home.
“Our interviews with veterans uncovered numerous accounts of returning service members whose unit leaders advised them to fabricate answers,” the report says. “Individuals across all services have been told, ‘If you answer yes to any of those questions, you are not going home to your family tomorrow.’
“This may be factually correct, but it neglects to inform service members of the implications of answering untruthfully – namely, that they will have difficulty receiving treatment or compensation for mental health problems that appear after their service.’‘
CNAS recommends that the military take further steps to encourage troops to complete the forms truthfully.
Also cited as problematic is a shortage of mental health care providers to treat both active duty troops and veterans. Research by the VA has found that suicide rates decreased by 3.6 deaths per 100,000 in seven regions where staff numbers increased to levels recommended in the 2008 Veterans Health Administration Handbook. Sixteen regions are still not manned to these levels, the report says. In addition, the Army has filled only 80 percent of its psychiatrist positions and 88 percent of its social work and behavioral health nurse jobs.
“Military hospital commanders have temporary authority to hire psychologists and social workers and behavioral health nurses on an as-needed basis, but a shortage of care providers precludes them from easily filling that gap,” the report says, noting that the shortage of mental health professionals is a national problem.
As dozens of other reports have found in recent years, the CNAS study cites the stigma associated with mental health problems as a key factor that prevents many service members from seeking care. More than 40 percent of service members who took their own lives in 2010 never sought help from military treatment facilities in the months before their deaths, according to the report.
While the percentage of service members seeking help has improved – from 36 percent in 2009 to 57 percent in 2010 – “the stigmatization of mental health care remains an issue,” the report concludes.
The full report, co-authored by Margaret C. Harrell and Nancy Berglass, senior fellows at CNAS, is available here.