By Penny Coleman
The silverbacks are grooming and posturing at the microphones.
Cammo and khaki, wall to wall. Bob Ireland, an Air Force psychiatrist and consultant to the Air Force Surgeon General, welcomes the audience to the Department of Defense’s sixth annual Suicide Prevention Conference and makes jokes about how suicide prevention has been the DoD’s bastard child, homeless and parentless.
In January 2008, the child nobody wanted finally managed to find a home. The Defense Center of Excellence for Psychological Health and Traumatic Brain Injury assumed responsibility for an issue and an injury that the military has hidden and denied for generations.
It’s been left up to Lt. Col. Steven Pflanz, the senior psychiatry policy analyst for the Air Force surgeon general, to report on the mental healthcare practices that have been developed for those on active duty. Kerry Knox, director of the VA’s Center for Excellence on Suicide Prevention, was scheduled to share with him these introductory remarks, but is not in attendance. Apologies are made, but no one mentions how obviously difficult it would be for her to get into the self-congratulatory HOOAH! spirit of this conference when her boss just got busted big time for hiding VA suicide statistics, not just to the media but to Congress as well.
"Shh!" Ira Katz, the VA’s mental health director, coyly began an email to the agency’s chief communications director -- and inconveniently made public just this week. "Our suicide prevention coordinators are identifying about 1,000 suicide attempts per month among the veterans we see in our medical facilities. Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?"
Ach, Katz, you little schemer.
In another email, he acknowledged that an average of 18 war veterans manage to kill themselves each day -- five of whom were under VA care at the time.
OK, Katz is toast. Democrats are already calling for him to resign, which seems rather mild considering how many lives were damaged by his attempts at damage control. But do the math: That’s 12,000 veterans a year -- VA patients -- trying to kill themselves. On top of that, of the 6,570 who on average succeed each year, 1,825 of them are also patients at the VA. How is possible not to mention that kind of news at a conference on military suicides?
This must have been a challenging week for the conference organizers. How to deal with the Katz e-mails and the new RAND Corporation report, which is devastating in its description of DoD and VA failures. And the RAND report can’t be blown off as the ravings of a bunch of leftists with an anti war agenda; RAND conducts research and analysis for the Office of the Secretary of Defense, the Joint Staff, the Unified Commands, the defense agencies, the Department of the Navy, and the U.S. intelligence community.
The report revealed that nearly 20 percent of military service members who have returned from Iraq and Afghanistan -- that’s 300,000 men and women -- have symptoms of post-traumatic stress or major depression. Of those, only slightly more than half have sought VA treatment. Soldiers say that hesitation to seek help arises from fear that it will harm their careers.
But word gets around. Even among those who do seek help, RAND estimates that only about half receive treatment their researchers consider "minimally adequate." So why bother.
The study also estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment, but that just 43 percent reported ever being evaluated by a physician for that injury, despite DoD’s policy that every soldier returning from Iraq be screened.
I would, of course, be very interested in DoD’s response to all of these accusations. At the risk of oversimplification, whatever it is they are doing isn’t working. This would be an obvious moment for a little humility and perhaps even an ideal audience to petition for new ideas.
Instead, Pflanz insists: "DoD has been living suicide prevention for a decade ... After bombs-on-target, the next most important thing is suicide prevention. I overuse that phrase," he admits, "but I think it drives home the point that we really do live and breathe suicide prevention."
I am taping this drivel, only listening with half an ear, and I’m reading about the trial that began Monday in San Francisco: Veterans’ groups are asking U.S. District Court Judge Samuel Conti, a World War II U.S. Army veteran, to order the VA to start providing immediate treatment for suicidal veterans and prompt care for those suffering from post-traumatic stress. Government lawyers argue that the courts don’t have the authority to tell VA how it should operate. That too would seem pertinent at a conference like this, but the trial hasn’t been mentioned either.
What brings my attention back to the room is a question from a man sitting at the end of my row of seats. In response to some of Pflanz’ brightly colored pie charts indicating what percentage of what demographic of soldiers are killing themselves, this man has asked whether or not those pie wedges take into account multiple deployments. "That information is redacted," says Pflanz definitively. What!?! The questioner smiles ruefully. He’s not surprised. I sense a friendly and move over to sit next to him.
James Conover is a three-tour Vietnam vet, a behavioral health specialist who has worked with veterans for 30 years. After he got out of the service, his life fell apart, and he admits that before he got it back together he seriously contemplated throwing himself off the seventh floor balcony of his building. James takes all this very personally.
Emboldened by my new ally, I ask if any of the services take into account what happens to their members after they come home. Are they counting their veteran suicides? "We have no information on that," he answers and refers me to Kerry Knox, who, as I mentioned before, is not present.
And as today’s news also includes a story about the administration’s decision to renege on their promise to end stop-loss, I ask if their studies take that into account. "There’s no easy access to that information."
It’s utterly fantastic -- all this stuff happening at the same time, all of it intimately related to the purported subject of this conference -- and all of it completely invisible.
Pflanz moves on to leadership. "The greatest impact on preventing suicide in the military is by, whenever they have a commander’s call, talking about healthy behavior, encouraging healthy behavior -- and coming across as if they really mean it."
James snorts. "Leaders. In Iraq, they call the behavioral health center ’the pink house.’ Commanders tell soldiers to get on down to the pink house."
So far, presenters from each service branch have included overcoming the stigma of accessing mental health services on their list of things that need to be improved. And so far, no one has said anything about how they propose to do that, but surely calling mental health services "pink" isn’t a positive contribution.
On a break in the presentations, I asked a senior chaplain if it might not be an effective leadership move for some of the senior command to set an example for their troops by admitting that they, like everyone else, have moments of weakness -- and that they have found it useful to reach out for help in those moments. He looked astonished and then amused by my innocence, and pronounced, "He’d never make flag."
(Steven Colbert would be glad to know that the background of choice for all the multicolored pies and mind-numbing numbers is a tight headshot of a beady-eyed eagle backed by a waving flag, an eagle I can’t look at anymore without thinking of his son, Steagle. )
Walter Morales is the Army’s suicide prevention manager. The suicide statistics in the Army are the most disturbing. At the end of 2007, the rate for completed suicides was 18.4 per 100,000, the highest since the Army started counting in 1980. The civilian suicide rate, which by the way does not reflect a population that is both young and screened for health, was 11 per 100,000, according to the latest figures from the CDC. And new Army figures show that 2,100 active-duty soldiers, Army alone, tried to commit suicide in 2007. That’s about six a day. Before the Iraq war began, that figure was less than one suicide attempt a day.
Morales presents the Army’s new initiatives. First there is ACE. ACE is a playing card, the ace of hearts to be exact. Printed on the back of the card is Ask your buddy. Care for your buddy. Escort your buddy. This card is used "Armywide," Morales boasts. "It plays a big role." But the cards are no longer in inventory. Maybe four weeks from now.
Commanders, who will be responsible for the Suicide Prevention Task Force, will soon be supplied with a "tool kit." This is a slightly larger card, but not so large, Morales points out, that it won’t fit in a hat band. It is printed with a checklist of warning signs and risk factors. Exposure to combat is not listed. And unfortunately, these cards are only available on line at the moment. In the meantime, Walter has received 48 entries in a suicide awareness poster contest.
There is one truth everyone here agrees on: The No. 1 stressor for soldiers of all stripes is failed relationships. Job-related problems, legal problems, financial problems each get a small slice of the colored pies, but the real culprits are us: the wives and husbands, the girlfriends and boyfriends, and of course the families. Exposure to combat? Not there.
A question: In the absence of combat trauma, how many broken hearts end in suicide?
This is not the first conference I have attended where what was happening in the halls was far more informative than the official fare. I’ll bet that some of the topics I missed hearing about were being run through the rumor mills around the refreshment tables, and that, as an obvious outsider, I was excluded. But this was a conference that was supposed to be addressing the tragic number of American soldiers and veterans who were ostensibly screened before they were allowed to enlist, and who, having been trained and used and dismissed by the various branches of the military, cannot find ways to live with what they have learned about themselves and their country.
Instead, a monstrous wrong is being done to our soldiers and veterans. The complete failure of any and all policies -- not to mention poster contests -- to put an end to this epidemic of death went entirely unacknowledged.
According to the RAND report, the new Defense Center of Excellence for Psychological Health and Traumatic Brain Injury and the new VA Center for Excellence on Suicide Prevention enter could provide "a historic opportunity to change the culture of psychological health within the military." But, warned Terri Tanielian, one of the lead researchers on the project, "(i)t’s going to take system-level changes -- not a series of small band-aids -- to improve treatments for these illnesses."
What was truly heartbreaking and frightening about this conference was that everything I saw presented looked like a band-aid, a mere cover-up for a wound that desperately needs serious attention. Either they don’t know that, or they don’t care -- or they were saving the good stuff for another audience.
Penny Coleman is the widow of a Vietnam Veteran who took his own life after coming home. Her latest book, Flashback: Posttraumatic Stress Disorder, Suicide and the Lessons of War, was released on Memorial Day, 2006. Her website is Flashback.
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