use what we already know…

Posted on Monday 8 October 2012


The Military Can Do More To Prevent Suicides
The Psychiatric Times
By Allen Frances, MD
October 8, 2012

James Dao reports in the October 8, 2012 New York Times that the military is considering 2 steps to reduce its startling rate of active duty suicides — which is approaching an unacceptable one suicide every day. Both measures are completely sensible, but neither goes nearly far enough. Privately owned guns and rifles are used in half of the suicides. The military would like to develop a program to engage friends and family in reducing the suicidal soldier’s access to his guns. It seems like the perfectly obvious thing to do. Suicide in the young is almost always an impulsive act — the best form of suicide prevention may be to make it less easily accomplished. This approach is exactly what every mental health worker learns is a vital part of suicide management. In fact, not to try to separate the suicidal person from the suicidal means is sometimes considered a cause for a malpractice suit.

But get this: as it stands now, commanders and military mental health personnel are by law not allowed to do anything about private firearms — even when a soldier is clearly at increased risk of killing himself. How can such foolishness possibly be? Last year the NRA pushed Congress into passing a law that forbids the military from any inquiry into the private firearms of its personnel. Just another obvious example of the NRA’s consistent over-reach beyond common sense or concern for public health and public safety. The American Foundation for Suicide Prevention is promoting a corrective new law, passed by the House but not yet by the Senate, that would restore the military’s right to ask about [but not to confiscate weapons] when there is a high risk of suicide. This a small step in the right direction but it obviously does not go far enough. It seems a no brainer that gun safety for suicidal troops should trump the NRA’s political clout used to subvert even the most obviously necessary forms of gun control.

The military’s second step would be to encourage friends and relatives to remove caches of prescription drugs collected by suicidal troops. It is disturbing to note that 1 in 8 soldiers [110,000] is on a psychotropic drug, and polypharmacy with drug cocktails is rampant. Legal drugs have become a bigger problem than illegal street drugs, and they are they cause more overdoses and deaths. The military needs to go much further. Confiscating caches is far too late in the game. There needs to be re-education on proper prescription habits, greater coordination among multiple prescribers, and much greater control on how pills are distributed.

It’s good to see Dr. Allen Frances back on the airways. I’ve missed his wisdom and directness. This is a topic he’s stayed on like he did the DSM-5 [betrayed our kids…][The Epidemic Of Military Suicide], and it deserves all the attention it can get. A few recent related items:
Suicide ‘epidemic’ in Army: July was worst month, Pentagon says
Christian Science Monitor
By Anna Mulrine
August 17, 2012

Today, suicide is the most frequent cause of death among Army forces, surpassing combat deaths and motor vehicle accidents, according to Gen. Raymond Odierno, the Army chief of staff. From 2004 to 2009, the suicide rate within the force doubled. The demographics are also changing. For the first time, there are more suicides among longer-serving non-commissioned officers than among young soldiers. The Pentagon is concerned, too, about the suicide rate among military veterans of the wars in Iraq and Afghanistan, particularly as one million troops prepare to leave the military by 2017. The rate among these veterans is higher than for active duty service members…

The majority of [suicides] have two things in common: alcohol and a gun. That’s just the way it is,” Gen. Peter Chiarelli, the Army’s former vice chief of staff, told the Monitor this January, shortly before he retired. “And when you have somebody that you in fact feel is high risk, I don’t believe it’s unreasonable to tell that individual that it would not be a good idea to have a weapon around the house”. However a new NRA-backed law prohibits the military from engaging in discussions about weapons and safety, military officials warn. “I am not allowed to ask a soldier who lives off-post whether that soldier has a privately-owned weapon,” General Chiarelli says…

Study reveals top reason behind soldiers’ suicides
USA TODAY
By Gregg Zoroya
07/11/2012

When researchers asked 72 soldiers at Fort Carson, Colo., why they tried to kill themselves, out of the 33 reasons they had to choose from, all of the soldiers included one in particular — a desire to end intense emotional distress… "The core of the issue is that it’s not that people who attempt suicide … want to harm themselves as much as they want the pain they’re currently in to stop, and they don’t see any other way out," Castro said.

The study also found that the soldiers often listed many reasons — an average of 10 each — for suicide, illustrating the complexity of the problem, Bryan said. Other common reasons included the urge to end chronic sadness, a means of escaping people or a way to express desperation. Meanwhile, a new Pentagon analysis released Tuesday shows that suicide rates in the military were highest among people divorced or separated — with a rate of 19 per 100,000 — 24% higher than troops who are single…

That NRA sponsored Bill/Rule is totally insane – "law prohibits the military from engaging in discussions about weapons and safety"! It should lead the nightly news until it’s repealed. But the thing I’d like to add are some of the points from the other articles. There are lots of things we know about military suicides, have known for a long time. "For the first time, there are more suicides among longer-serving non-commissioned officers than among young soldiers." First time? In World War I, the higher the rank, the longer the service, the greater the suicide risk. That rates are "highest among people divorced or separated" is true across the board for suicide in any situation. And "alcohol and a gun" has been a suicide cocktail since guns were invented. People tend to forget that PTSD is among the most painful mental illnesses – "they want the pain they’re currently in to stop." So, if someone’s in enough emotional pain to genuinely require psychoactive medications to function, particularly when deployed, it’s time to come home.

One thing we know about PTSD – the longer you’re at war, the more likely you are to have it in some flavor. This policy of repeated deployment, even though it’s voluntary, is wrong for lots of reasons, but this is number one. Chronic Combat changes the world view of a person profoundly, maybe permanently. We’re most likely doing it to avoid reviving the draft. The parents of America would have shut these wars down when they should’ve been shut down if we had a draft. By multiply deploying volunteers, there’s much less call to end a chronic conflict. But that’s a political polemic. More to the point, chronic combat deployment is a recipe for suicide and lifelong mental illness. We knew that and we shouldn’t have done it. We sure shouldn’t still be doing it. It’s just not good for people.

I’m afraid that this time, the military command has done a reasonable job with mental health, but the policy decisions in Washington have dampened anything they’ve tried…
  1.  
    October 9, 2012 | 1:13 PM
     

    Don’t forget the adverse effects of taking psychiatric drugs inconsistently or without proper monitoring for drug-drug interactions or side effects.

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