thedrifter
09-03-07, 07:52 AM
War-zone stress revealing itself in suicidal thoughts
By Kelly Kennedy - kellykennedy@militarytimes.com
Posted : September 10, 2007
ASAD, Iraq — Standing on a landing pad outside the 399th Combat Support Hospital here, a group of military police wait for the next patient to arrive by helicopter.
It’s a soldier. He’s suicidal, and he’s acting out.
“On the last tour, it was [post-traumatic stress disorder],” said Army Lt. Col. Graham Hoffman, hospital psychiatrist. “This time, it’s suicide — suicidal thoughts. It’s increasing.”
Of the 15 people he has shipped to Landstuhl Regional Medical Center in Germany for suicidal thoughts or suicide attempts, one-third have been Marines, the rest soldiers, he said, which shows the problem is not Army-specific.
“This tour, only about 20 percent are coming in for PTSD,” said Hoffman, who is on his third tour. “But 80 percent is burnout and depression.”
He sees more than 100 patients regularly. “I don’t have time to keep statistics,” he said. “There are not enough therapists.”
In a report released the week of Aug. 13, Army researchers found that 74 soldiers tried to commit suicide in Iraq or Afghanistan in 2006, and 27 more succeeded. Most were white, male and young, and had committed or tried to commit suicide within six months of arriving in theater.
Nine weeks of interviews with mental health care workers and service members in Iraq show the problems don’t appear to be the same from base to base. However, they say all the problems fall into the category of “stress”: relationship issues, not enough time between deployments, boredom, dread of returning to theater, deployment extensions and not enough time off.
The problem, they say, may be worse than the statistics in the latest report show: Suicidal gestures — such as swallowing a handful of pills — don’t count as suicide attempts. Also, therapists themselves have differing information about a suicide prevention program in theater; some say it has been in full swing since the start of the Iraq war, others say there is no program.
In reality, an official suicide prevention program just for Iraq is only now being launched. Last fall, the Defense Department’s Mental Health Advisory Team found suicide-prevention training in Iraq has been spotty at best, and recommended creating a program just for deployed troops.
On May 1, Army Lt. Col. Michael Russell filled a new position at Medical Command headquarters in response to the rise in the suicide rate.
Army Col. Carroll Diebold, theater mental health consultant with the 62nd Medical Brigade in Baghdad, said the length of deployments and open-ended deployments are the biggest complaints — especially when troops are extended.
“It’s continuous readiness now,” he said. “You have to refit your people, too. This is � a big issue.”
He said the suicide prevention program has been bolstered to make it theater-specific and runs through the whole deployment, with briefings, family readiness groups and education for leaders.
Even with the extra training, challenges seem to be growing. All the services have worked to kill the stigma associated with seeking mental health care, but it still stands strong in some units.
Around midmorning, Hoffman goes to talk with a soldier in the intensive care unit. This one tried to kill himself twice while in Iraq.
“He said his command said he would not be promoted if he went to mental health,” Hoffman said. “And that other guys in his unit who had sought mental health treatment were not getting promoted. If he had gotten the treatment he needed in the first place, he might not be here now.”
Hoffman sent the soldier to Landstuhl.
“The bad commanders are saying, ‘Shut up, toughen up,’” he said. “About half the units actively send their guys to mental health.”
But it’s more than going to see the doc, Hoffman said. Often, leaders don’t know what their soldiers or Marines face because they remain at big bases in air-conditioned offices, rather than at the tiny outposts where troops often live in austere conditions: port-a-johns, 20 men per room, several patrols a day and meals brought in by truck rather than made on-site.
“The lower ranks are suffering the brunt of it,” Hoffman said. “A lot of leaders don’t go out.”
And, as Iraq becomes more garrison-like, with more support troops than infantry, Hoffman said the gap between conditions on the forward operating bases and outside the wire has grown. Hoffman works seven days a week and said he doesn’t have the time he needs to talk to all the guys who need it.
Defense officials always issue suicide numbers with this caveat: “It’s much lower than the civilian population.”
The latest report came with the same comparison: The Army suicide rate per 100,000 soldiers stands at 17, while the U.S. adjusted rate for age and gender to match military demographics stands at 19. The Army’s suicide rate usually stands at 11 per 100,000.
The soldiers don’t buy it.
“We’re screened before we join,” said Sgt. 1st Class Chad Smith, an aid-station medic with 1st Battalion, 26th Infantry. “That sorts out a lot of the mentally ill to begin with. So to say that we’re at 17 out of 100,000 for a suicide rate and then to say, ‘That’s still below the civilian rate,’ you have to put it into context.”
To Smith, the reasons behind the suicides seem clear.
“It’s a direct reflection of how we’re dealing with stress,” he said. “When you stop trying to defend everything and just look at it for what it is, it becomes obvious. We need to have that hope — that they’re working on it, that they do understand what’s going on. Otherwise, it looks like excuses and lies.”
That stress presents itself in many ways, but each therapist cited how a breakup can lead to a life-ending decision, rather than a week of heartbreak, if a service member gets a Dear John or Dear Jane letter in theater.
“That’s the primary reason we see people,” said Maj. John Gourley, chief of the 85th Combat Stress Control unit in Mosul, Iraq. “They’re saying they’re going to hurt themselves because of what’s going on back home.”
He also has sent a few service members home, but he said the best thing therapists can do is try to get them back to their units, because often all people need is some time off and some sleep.
But more enlisted mental health technicians also may help, he said. “They may not believe I understand how they’re feeling and that their hearts are broken,” Gourley said. “But they may believe somebody their own age.”
Cmdr. Beverly Dexter, Combat Stress and Readiness Clinic psychologist at Asad, said she, too, focused on relationships after working with troops, but also after standing in line with them to talk with her husband at the call center.
“You’ll hear them screaming and cussing on the phones,” she said. “Tiny problems at home just explode when combined with stress here.”
She created a program, “Call Home With Love,” that includes posters above the phones at the call center with friendly messages to repeat to loved ones, as well as laminated tip sheets she hands out to help people remember faulty plumbing isn’t reason for divorce and that spouses at home are stressed, too.
And, if a service member tells her he’s getting a divorce, she calls the spouse back home and asks that person to wait until the end of the deployment.
“Then, I can get real busy working with the person out here getting what he needs,” she said. “We do things out here to improve their relationships.”
That, she said, creates hope, which can end suicidal thoughts.
As the military tracks the rising suicide rate, experts are also trying to figure out if people are getting the help they need. Often, the first place people go is the unit chaplain.
“I’ve taught suicide prevention classes three or four times since I’ve been here,” said Chaplain (Capt.) Stephen Dicks, of the 28th Combat Support Hospital in Mosul. “Roommates or best friends will notice long before the chaplain will, so that’s our main push: Make sure everyone knows what to look for.”
He teaches them to listen for key phrases or watch for changes in personalities. He talks to someone who has suicidal thoughts or who has made a suicide gesture every two or three weeks, he said.
“If you take five sleeping pills, it’s not enough to hurt you, so it’s a suicide gesture,” he said. “A lot of times, it’s an attempt to be helped.”
Sometimes, it may come down to too much time to think about things. Army Maj. Tykise Hairston, head nurse at the 28th Combat Support Hospital, said she saw a lot more suicide attempts when she was based in Tillil — where more service members did not go outside the wire. At Mosul, with its constant mortar attacks and gunfights, soldiers and Marines spend a lot of time on patrol.
“In Tillil, they had nothing going on,” she said. “But they’re busy here. That has to be it.”
Still, she remains on alert.
“We just had a suicide attempt at our unit in Baghdad,” she said. “All you can do is look out for each other and take it one day at a time.”
By Kelly Kennedy - kellykennedy@militarytimes.com
Posted : September 10, 2007
ASAD, Iraq — Standing on a landing pad outside the 399th Combat Support Hospital here, a group of military police wait for the next patient to arrive by helicopter.
It’s a soldier. He’s suicidal, and he’s acting out.
“On the last tour, it was [post-traumatic stress disorder],” said Army Lt. Col. Graham Hoffman, hospital psychiatrist. “This time, it’s suicide — suicidal thoughts. It’s increasing.”
Of the 15 people he has shipped to Landstuhl Regional Medical Center in Germany for suicidal thoughts or suicide attempts, one-third have been Marines, the rest soldiers, he said, which shows the problem is not Army-specific.
“This tour, only about 20 percent are coming in for PTSD,” said Hoffman, who is on his third tour. “But 80 percent is burnout and depression.”
He sees more than 100 patients regularly. “I don’t have time to keep statistics,” he said. “There are not enough therapists.”
In a report released the week of Aug. 13, Army researchers found that 74 soldiers tried to commit suicide in Iraq or Afghanistan in 2006, and 27 more succeeded. Most were white, male and young, and had committed or tried to commit suicide within six months of arriving in theater.
Nine weeks of interviews with mental health care workers and service members in Iraq show the problems don’t appear to be the same from base to base. However, they say all the problems fall into the category of “stress”: relationship issues, not enough time between deployments, boredom, dread of returning to theater, deployment extensions and not enough time off.
The problem, they say, may be worse than the statistics in the latest report show: Suicidal gestures — such as swallowing a handful of pills — don’t count as suicide attempts. Also, therapists themselves have differing information about a suicide prevention program in theater; some say it has been in full swing since the start of the Iraq war, others say there is no program.
In reality, an official suicide prevention program just for Iraq is only now being launched. Last fall, the Defense Department’s Mental Health Advisory Team found suicide-prevention training in Iraq has been spotty at best, and recommended creating a program just for deployed troops.
On May 1, Army Lt. Col. Michael Russell filled a new position at Medical Command headquarters in response to the rise in the suicide rate.
Army Col. Carroll Diebold, theater mental health consultant with the 62nd Medical Brigade in Baghdad, said the length of deployments and open-ended deployments are the biggest complaints — especially when troops are extended.
“It’s continuous readiness now,” he said. “You have to refit your people, too. This is � a big issue.”
He said the suicide prevention program has been bolstered to make it theater-specific and runs through the whole deployment, with briefings, family readiness groups and education for leaders.
Even with the extra training, challenges seem to be growing. All the services have worked to kill the stigma associated with seeking mental health care, but it still stands strong in some units.
Around midmorning, Hoffman goes to talk with a soldier in the intensive care unit. This one tried to kill himself twice while in Iraq.
“He said his command said he would not be promoted if he went to mental health,” Hoffman said. “And that other guys in his unit who had sought mental health treatment were not getting promoted. If he had gotten the treatment he needed in the first place, he might not be here now.”
Hoffman sent the soldier to Landstuhl.
“The bad commanders are saying, ‘Shut up, toughen up,’” he said. “About half the units actively send their guys to mental health.”
But it’s more than going to see the doc, Hoffman said. Often, leaders don’t know what their soldiers or Marines face because they remain at big bases in air-conditioned offices, rather than at the tiny outposts where troops often live in austere conditions: port-a-johns, 20 men per room, several patrols a day and meals brought in by truck rather than made on-site.
“The lower ranks are suffering the brunt of it,” Hoffman said. “A lot of leaders don’t go out.”
And, as Iraq becomes more garrison-like, with more support troops than infantry, Hoffman said the gap between conditions on the forward operating bases and outside the wire has grown. Hoffman works seven days a week and said he doesn’t have the time he needs to talk to all the guys who need it.
Defense officials always issue suicide numbers with this caveat: “It’s much lower than the civilian population.”
The latest report came with the same comparison: The Army suicide rate per 100,000 soldiers stands at 17, while the U.S. adjusted rate for age and gender to match military demographics stands at 19. The Army’s suicide rate usually stands at 11 per 100,000.
The soldiers don’t buy it.
“We’re screened before we join,” said Sgt. 1st Class Chad Smith, an aid-station medic with 1st Battalion, 26th Infantry. “That sorts out a lot of the mentally ill to begin with. So to say that we’re at 17 out of 100,000 for a suicide rate and then to say, ‘That’s still below the civilian rate,’ you have to put it into context.”
To Smith, the reasons behind the suicides seem clear.
“It’s a direct reflection of how we’re dealing with stress,” he said. “When you stop trying to defend everything and just look at it for what it is, it becomes obvious. We need to have that hope — that they’re working on it, that they do understand what’s going on. Otherwise, it looks like excuses and lies.”
That stress presents itself in many ways, but each therapist cited how a breakup can lead to a life-ending decision, rather than a week of heartbreak, if a service member gets a Dear John or Dear Jane letter in theater.
“That’s the primary reason we see people,” said Maj. John Gourley, chief of the 85th Combat Stress Control unit in Mosul, Iraq. “They’re saying they’re going to hurt themselves because of what’s going on back home.”
He also has sent a few service members home, but he said the best thing therapists can do is try to get them back to their units, because often all people need is some time off and some sleep.
But more enlisted mental health technicians also may help, he said. “They may not believe I understand how they’re feeling and that their hearts are broken,” Gourley said. “But they may believe somebody their own age.”
Cmdr. Beverly Dexter, Combat Stress and Readiness Clinic psychologist at Asad, said she, too, focused on relationships after working with troops, but also after standing in line with them to talk with her husband at the call center.
“You’ll hear them screaming and cussing on the phones,” she said. “Tiny problems at home just explode when combined with stress here.”
She created a program, “Call Home With Love,” that includes posters above the phones at the call center with friendly messages to repeat to loved ones, as well as laminated tip sheets she hands out to help people remember faulty plumbing isn’t reason for divorce and that spouses at home are stressed, too.
And, if a service member tells her he’s getting a divorce, she calls the spouse back home and asks that person to wait until the end of the deployment.
“Then, I can get real busy working with the person out here getting what he needs,” she said. “We do things out here to improve their relationships.”
That, she said, creates hope, which can end suicidal thoughts.
As the military tracks the rising suicide rate, experts are also trying to figure out if people are getting the help they need. Often, the first place people go is the unit chaplain.
“I’ve taught suicide prevention classes three or four times since I’ve been here,” said Chaplain (Capt.) Stephen Dicks, of the 28th Combat Support Hospital in Mosul. “Roommates or best friends will notice long before the chaplain will, so that’s our main push: Make sure everyone knows what to look for.”
He teaches them to listen for key phrases or watch for changes in personalities. He talks to someone who has suicidal thoughts or who has made a suicide gesture every two or three weeks, he said.
“If you take five sleeping pills, it’s not enough to hurt you, so it’s a suicide gesture,” he said. “A lot of times, it’s an attempt to be helped.”
Sometimes, it may come down to too much time to think about things. Army Maj. Tykise Hairston, head nurse at the 28th Combat Support Hospital, said she saw a lot more suicide attempts when she was based in Tillil — where more service members did not go outside the wire. At Mosul, with its constant mortar attacks and gunfights, soldiers and Marines spend a lot of time on patrol.
“In Tillil, they had nothing going on,” she said. “But they’re busy here. That has to be it.”
Still, she remains on alert.
“We just had a suicide attempt at our unit in Baghdad,” she said. “All you can do is look out for each other and take it one day at a time.”