“Understanding of the whole person and ensuring that the whole person is equipped to face what we are asking them to do. We are inviting people into a loving community and we are asking a lot of them, so we must prepare them for their very worst day,”………. MG Thomas Solhjem, 25th Army Chief of Chaplains
By Kris Osborn, President, Center for Military Modernization
(Washington DC) US Army post-combat soldier suicides are unspeakably traumatic, devastating and tragic, as they often both end lives with unwanted violence and shatter other lives with loss and life-long pain and confusion. Perhaps no-one can fully comprehend or analyze the ineffable mixture of variables which ultimately cause such tragedy, yet the complexity of the task has not slowed down what could be described as the Army’s increasingly intense “war on suicide.”
Suicide prevention and resilience, long emphasized in the Army, has taken on new urgency in recent decades during and after the wars in Iraq and Afghanistan because, as Defense Secretary Lloyd Austin writes, “one death by suicide is too many.” The numbers of veteran suicides are alarming, as they have increased massively in the last several decades since the beginning of the Iraq and Afghanistan wars. An interesting essay from the American Addiction Centers reports that, in 2020, there were 6,146 veteran suicides, an average of 16.8 per day.
“Additionally, in the two decades between 2001 and 2020, the prevalence of mental health or substance use disorder (SUD) among participants using Veterans Health Administration (VHA) rose from 27.9% to 41.9%,” the essay states.
There may simply be no words which can capture the irreparable pain and loss caused when soldiers who risk their lives for all of us tragically take their own lives amid pain, confusion, guilt and the pure trauma of war. Although language itself may seem insufficient to capture the limitlessness of the loss, pain and emotional wreckage caused by soldier suicide, it aligns with dark phrases used by Mary Shelley in her famous 19th Century Gothic Novel Frankenstein wherein she uses descriptions such as “heart sickening despair,” “devouring blackness of melancholy” and “your disaster is irreparable.” Indeed there may be some pains and traumatic events which themselves defy description and for which there is ultimately no answer or reasonable explanation. However, these complexities are not impeding the Army’s massive, comprehensive, community and nation-wide campaign to stop soldier suicide. Should one life be saved because one suicide was prevented, then the entire effort of the Army and joint community would be more than worth it.
Certainly, prevention efforts have already saved lives, a reason perhaps why the Department of Defense and the Department of the Army continue to massively accelerate, expand and uptick suicide prevention initiatives.
While suicide prevention has long been on the radar with the Army, the need has become even more pressing in light of continued statistics and soldier suicide rates which simply remain much too high. With this in mind, Secretary of Defense Lloyd Austin launched a specific, measured effort in 2022 to break new ground in the ongoing battle to save lives of those who suffered in combat. In March of 2022, Austin established the Suicide Prevention and Response Independent Review Committee, an integrated, multi-faceted initiative to better understand and therefore prevent soldier suicide.
The review committee, as identified in a memo from Secretary Austin, will require visits to specific military installations, focus groups, individual interviews, and a confidential survey of Service members at the designated locations. The SPRIC will ultimately complete a comprehensive and detailed report for the Secretary of Defense and Congressional Armed Services Committees.
Further details related to the SPRIRC effort were explained in a May 17, 2022 memo from the Under Secretary of Defense Colin Kahl, which specified that the independent review committee will consist of a diverse range of sophisticated experts from a wide sphere of areas of expertise including faith, spirituality, leadership, psychological experts and specialists in the areas of soldier experience and military family life.
“In order to balance the need for independent views and military cultural familiarity, the membership of the SPRIRC consists of independent subject matter experts with backgrounds and experiences collectively representing the public health approach to suicide prevention, clinical services for mental health, suicide epidemiology, the overlap between sexual assault and suicide behavior,and lethal means safety,” the memo from the Undersecretary of Defense writes.
As for some of the specific elements of SPRIRC, the Under Secretary of Defense explained that efforts will include policy reviews, installation visits, focus groups, individual interviews and a “confidential survey of service members stationed at the designated locations.”
Army Resilience, Spiritual Readiness & “Team” Prevention
Recognizing that emotional distress, spiritual bankruptcy and risk of suicide relate heavily to experiences in life such as combat trauma, loss of loved ones, relationship crises or other catastrophic developments, the Army has itself launched what could be called a “War on Suicide” through a program called Holistic, Health and Fitness, or H2F program.
MG Thomas Solhjem, the 25th Army Chief of Chaplains, is deeply immersed in offering spiritual and emotional guidance, yet he emphasizes that ultimate prevention responsibility also rests with Army leaders, individual teammates and soldiers themselves. Raising awareness, encouraging communication and, perhaps most of all, ensuring those suffering that there is no “shame” in admitting vulnerability are essential to the effort, Solhjem explained.
A soldier with an emotional injury and trauma from combat is no less injured in many cases than a soldier suffering a gunshot-wound, as it is simply a different kind of wound. Therefore, removing any stigma attached to mental health pain, dismantling preconceived notions and challenging ineffective historical narratives can prove paradigm-changing for potential victims of suicide. This not only lessens any sense of isolation but also sends a clear message to those in pain that admitting emotional vulnerability is actually a tremendous sign of strength and toughness. Resilience, healing and prevention are therefore more likely to take place when those suffering are encouraged to have the courage, resolve and honesty to recognize that asking for help is a tremendous sign of strength. The Army community’s approach and emphasis with the H2F program is very much grounded in this concept, Solhjem explained.
“Spiritual readiness comes from leaders, individuals, teammates and the Chaplain Corps alongside training assistance and counseling. Embracing H2F is everyone’s opportunity and everyone’s responsibility,” Solhjem explained in a special Association of the United States Army Video called Soldier Readiness:Suicide Prevention. 1. “Understanding of the whole person and ensuring that the whole person is equipped to face what we are asking them to do. We are inviting people into a loving community and we are asking a lot of them, so we must prepare them for their very worst day.”
Solhjem’s comment seems to emphasize the importance of anticipating the possibility of loss and emotional pain through a wholistic, integrated community approach to the entire person and the complexity and power of human emotional experience. Further
elaborating upon this point, Solhjem cited relevant scientific findings which finds that only 30-percent of someone’s spiritual “core” is linked to what they are born with, as compared with 70-percent resulting from socialization or, essentially, experiences in life. These percentages pertain to the somewhat timeless and often explored nature vs. nurture discussion which has often sought to better understand the delicate mixture of life experience and genetics as they impact behavior and personality. Solhjem’s point was that “experiences” were of course critical to mental health in terms of the origins of pain and trauma and efforts to mitigate, combat or remove them.
“Well-Checks” – Suicide Can be Triggered by Non-Combat-Related Crisis
Dr. James Hellis, who directs the Army Resilience Directorate, explained that “triggers” or pivotal moments that can lead to actual suicide attempts are often not the specific result of warzone trauma per say. He said they often pertain to compounding added factors such as a personal relationship crisis, substance abuse experience, profound loss or financial ruin. While many of these events can of course bear some clear relation to PTSD and warzone-experienced trauma, the actual “suicide” itself can be precipitated by additional factors not specific to combat. in many cases. There is no particular demographic trend or specific conditions which can decisively be linked to suicide, although Hellis explained that the science does point to a number of critical variables. There has been an increase in the volume of suicides, Hellis said, and they typically include soldiers 21-to-29 who have served in “combat arms” and are in some level of crisis.
Also, actual completed suicides do align, quite simply, with the availability of private weapons. Specifically, 70-percent of death by suicide come from firearms that are privately owned weapons, a statistic which unequivocably points to the need for “safe weapons” practice at home which include reduced or limited access to firearms in some cases. The suicide prevent effort can also benefit from deliberate efforts to reduce the likely of an overdose or abrupt violent outburst by remove prescription drugs if they are no longer needed or “locking up” firearms to be accessed only in specific, safe circumstances.
A fundamental element driving healing and success in the Army’s resilience-suicide prevention campaign, Hellis explained, relates to the practice of performing “100-percent” annual wellness checks of soldiers at high risk of suicide. The process, which has already been implemented with the Army’s 1st Infantry Division, Fort Riley, Kansas, to ensure that every soldier goes to a “military & family life consultant to check in” to, as Hellis explained, “identify soldiers before a crisis. In many cases, Hellis explained simple act of sending a clear and decisive “we care about you” message to soldiers suffering emotional pain from combat through a wellness check can prove extremely impactful when it comes to prevention, as at risk soldiers can learn they are part of a caring community and do not have to suffer alone. Maj. Gen. Solhjem closely aligns with Hellis’ emphasis here and believes that soldiers on a “team” are 80-percent more protected against a negative outcome.
“We know how to triage,” Solhjem explained, as a way to draw parallels between physical injury protection and detection and equally devastating emotional injuries which also need to be protected against and detected. This involves what could be described as a “layered” approach, Solhjem explained, indicating that detection can begin with a small unit leader as a first line of defense or result from the well-known and extremely powerful “circle of trust” soldiers build with one another in combat.
Sure enough, the importance of “team” was highlighted at the inception of Secretary Austin’s Suicide Prevention effort.
“We have the strongest military in the world because we have the strongest team in the world. It is imperative that we take care of all our teammates and continue to reinforce that mental health and suicide prevention remain a key priority,” Austin writes in his March 2022 memo.
Hellis and Solhjem’s emphasis upon the community and team-focused aspects of the Army community can prove vital to saving lives of soldiers contemplating suicide, as veterans experiencing specific trauma related to warzone violence might experience a sense of isolation with their pain or feeling misunderstood. Many sufferers of PTSD can present extremely well in many circumstances without necessarily exhibiting alarming systems, which is why a preventative well-check could prove decisive. Other key indicators and warning signs can include excessive anxiety, fear or extreme hyper-vigilance, emotional volatility, concerning outbursts of behavior and expression or simply consistent, debilitating emotional pain. Without sharing this pain or finding others with whom to relate or connect, trauma sufferers may experience feelings of hopelessness, shame, self-blame or isolation. These are the reasons why community is so fundamental to resilience and suicide prevention, Hellis mentioned, explaining that most soldiers have extensive, lasting and emotionally powerful experiences with team-work from their time in Army units.
The Army’s discussion of annual “well-checks” aligns closely with suicide prevention guidelines emphasized by the National Institute of Mental Health which instructs loved ones, observers, friends and caretakers to look for a number of key problem indicators. Things to look for, as outlined by the NIMH paper, include a soldier who is “researching ways to die, withdrawing from friends, making a will, taking dangerous risks or using drugs and alcohol more often.”
These findings are also supported in a relevant 2006 essay from the American Association of Suicideology called “Warning Signs for Suicide: Theory, Research, and Clinical Applications,” .2
“Most frequently identified warning signs have included thoughts of suicide; obsessions with death; writing about death; sudden changes in personality, behavior, eating, or sleeping patterns; feelings of guilt; and decreased academics or work,” the essay states.
These warning signs are certainly the kinds of things that Army “well-checks” would be well-positioned to identify, and finding areas of possible concern before they become catastrophic could likely be a positive outcome emerging from the checks.
Relevant research also supports the Army’s emphasis upon potential “intervention” such as the extent to which well-checks can identify “risk-factors” or indicate a more pressing need to take action. In fact, risk factors and a need for rapid intervention are often closely intertwined.
“The presence of a risk factor that elevates the long-term probabilistic risk for a suicidal crisis, in which warning signs indicate the presence of an actual suicidal crisis. Thus, the presence of warning signs would, by definition, demand specific and immediate intervention,” the essay explains.
Army “Team” & “Community” in War Can Help Stop Suicide
Solhjem’s mention of statistics indicating that soldier connected to a team are much less likely to contemplate or commit suicide seems quite significant, as a sense or belonging and purpose among others can prevent or minimize feelings of hopelessness and despair.
There are far too many instances of personal sacrifice, heroism and “team” throughout the long history of the US Army’s involvement in warfare to ci
te, yet the concept of “team” and “circle” of trust was demonstrated in an indescribable manner in many combat scenarios during the wars in Iraq and Afghanistan. There are several famous examples where a sense of purpose, team and belonging appears to have saved lives, a circumstance which sheds further light on Solhjem’s statistics. Demonstrations of team and purpose can minimize the likelihood that a given soldier will contemplate suicide or exhibit suicidal sensibilities.
A famous instance of teamwork and a life-saving sense of purpose took place during the War in Afghanistan in 2009 when Taliban fighters began to overrun Combat Outpost Keating in the Nuristan Province. Medal of Honor recipient Clint Romesha inspired a small group of Army soldiers to join his “counterattack” to repel Taliban invaders and “take-back” the Outpost. Refusing to refer to himself in heroic terms, Romesha named the soldiers who died in the battle. The intensity of devotion to his fellow soldiers, motivated by loyalty, love and protective instinct, provided the inspiration for Romesha’s actions in combat
“It wasn’t a day of hatred toward the enemy. It mattered about those brothers to your left and your right – we did not fight because we hated the guys who were attacking us, we did it more because we loved the guys that were on our left and right. Love will win out over hate and anger any day of the week,” Romesha told me in a discussion years ago for an essay for Warrior Maven.3.
Romesha’s experiences related to the perils of combat, and the depth of love for his living and fallen fellow soldiers, captures the sensibility informing the Army’s community-focused effort to prevent soldier suicide.
Yet another instance of soldier “team” which bears upon suicide prevention can be seen in the near fatal injuries sustained by former Green Beret Dillon Behr in Shok Valley, Afghanistan, 2008.
Behr recalls seeing a distant, flashing image of blue sky, rolling mountains and snowy rivers after having narrowly escaped death in a violent firefight on the ground below – just barely beyond view from the naked eye.This vivid, yet paradoxical scene is what Behr recalls seeing when looking down in a weary, half-conscious state from a Black Hawk helicopter while being evacuated from a near-death combat encounter in the mountains of Afghanistan.
“I was able to look back in the valley below and see a lot of my teammates still there fighting. It was a beautiful scene from a distance, yet what had just happened down below was basically hell on earth,” Behr said in discussion with me several years ago for an essay in Warrior Maven. 4.
This violence and near death for Behr is now known as the famous battle of Shok Valley in Afghanistan, 2008; the mission on that April day was called “Operation Commando Wrath.”
What Can Be Done to Prevent and Stop Suicide?
Looking at these two examples of a collective Army sense of “team” and “purpose” demonstrates that indeed vigorous commitment to unit and team has a life affirming function.
Building upon this effort to emphasize “team,” the Army is also supporting a number of cutting edge research efforts to identify and treat combat-related trauma, much of which can of course lead to potential suicide. More than 10-years ago, for instance, the Army’s Program Executive Office STRI implemented an innovative method of using technology and combat simulation to help soldiers recover from PTSD and combat-related trauma. In essence, the concept was to use gaming-type simulation technology to expose soldiers to potentially traumatic combat scenarios, and then resolve them without injury or trauma. The idea is to expose suffering soldiers to conditions which may give rise to PTSD and function as a “trigger,” yet prevent the trigger from reactivating PTSD symptoms and instead lead to a calm resolution. This can help soldiers with PTSD learn to avoid being triggered and confront, “but resolve” stressful scenarios which might otherwise cause trauma. More recently, the Army’s Study Program Management Office, called the ASPMO, extends analysis and findings from a successful training and simulation exercise to aid in this kind of treatment and prevention of PTSD. The analysis is referred to as “optimizing human performance and discouraging PTSD,” according to a 2013 report from PEO STRI called “Is Mental Armor Possible.” 5.
Sure enough, the training program involved simulation and may have built upon previous work done by the PEO. It was called TADSS (Training, Aids, Devices, Simulator and Simulations) Integration and Technology Insertion Roadmap to Achieve Squad Overmatch.”
“The US Army is extremely good at training Soldiers in the eight forms of contact and getting them to perform those actions automatically. We do not prepare them, however, for the actual traumatic events that occur when engaging in combat,” the authors state in the essay.
Overall, the Army’s multi-pronged effort to fight suicide, which aligns with and supports the Pentagon’s ongoing Suicide Prevention and Response Independent Review Committee initiative, recommends a blend of strategic efforts merging education with intervention. A blended approach that seeks to raise awareness, yet also set clear parameters for rapid intervention when necessary, is supported by expert psychological research. Simply put, education and intervention … can work.
A 2021 research study highlighted in the American Journal of Psychiatry called “Improving Suicide Prevention Through Evidence-Based Strategies,”6. states that both intervention and targeted efforts to raise awareness can massively reduce suicide rates.
The research found, for instance, that helping primary care doctors identify signs of depression, anxiety or mental distress helps identify warning signs and prevents suicides. This aligns closely with what Solhjem and Helis explained about implementing “well checks” as a way to screen for and identify suicidal risks earlier in the treatment process.
“Training primary care physicians in depression recognition and treatment prevents suicide. Educating youths on depression and suicidal behavior, as well as active outreach to psychiatric patients after discharge or a suicidal crisis, prevents suicidal behavior,” the essay states.
The American Journal of Psychiatry also lends additional support to the Army’s discussed recognition that actual “suicidal” behavior can be motivated by a specific or catastrophic life event.
“Suicide risk can be understood in terms of a stress-diathesis model in which stress results from an internal stressor, usually a psychiatric illness, present in about 90% of all cases of suicide and most commonly major depression, and/or an external stressor involving life events,” the study states.
************“We have the strongest military in the world because we have the strongest team in the world. It is imperative that we take care of all our teammates and continue to reinforce that mental health and suicide prevention remain a key priority,”……. Defense Secretary Lloyd Austin. “One death by suicide is one too many. And suicide rates among our Service members are still too high. So, clearly we have more work to do.” ************
Kris Osborn is the Military Affairs Editor of 19FortyFive and President of Warrior Maven – Center for Military Modernization. Osborn previously served at the Pentagon as a Highly Qualified Expert with the Office of the Assistant Secretary of the Army—Acquisition, Logistics & Technology. Osborn has also worked as an anchor and on-air military specialist at national TV networks. He has appeared as a guest military expert on Fox News, MSNBC, The Military Channel, and The History Channel. He also has a Masters Degree in Comparative Literature from Columbia University.
***************** Endnotes******************
- AUSA’s Noon Report – Suicide Prevention – 3-8-2023. Dr. James Helis, Director, Army Resilience Directorate & MG Thomas Solhjem, 25th Chief of Chaplains. Video Production
- “Warning Signs for Suicide: Theory, Research and Clinical Applications.” The American Association of Suicidology. Suicide and Life Threatening Behavior, June 2006. (M. David Rudd, PhD, ABPP, Alan L. Berman, PhD, ABPP, Thomas E. Joiner, Jr., PhD, Matthew K. Nock, PhD, Morton M. Silverman, MD, Michael Mandrusiak, MSCP, Kimberly Van Orden, MS, and Tracy Witte, BS)
- “Afghanistan Remembered: Counterattack on Taliban At Combat Outpost Keating,” Warrior Maven: Center for Military Modernization, April 13, 2023
- “Afghanistan Remembered: Taliban Ambush – Green Beret Survives Multiple Gunshots, Escapes Death” Warrior Maven, Center for Military Modernization, April 12, 2023
- “Is Mental Armor Possible.” US Army, PEO STRI 2013
- “Improving Suicide Prevention Through Evidenced-Based Strategies: A Systematic Review.” Journal of American Psychiatry, Feb 18, 2021. John Mann, M.D., Christina A. Michel, M.A., Randy P. Auerback, Ph.D
