Restrict the Kennedys' access to cars first, and then you can worry about firearms.
Posted on 12/03/2012 11:16:25 PM PST by Jet Jaguar
The horror of war, repeated deployments, the operations tempo, failed relationships, financial problems, legal trouble, depression, PTSD, TBI.
Many reasons have been suggested to explain the substantial rise in the suicide rate of soldiers that began in 2004.
Numerous prevention efforts were launched, hundreds of millions of dollars spent on studies and task forces, resilience programs and increasing access to mental health care.
Yet eight years and hundreds of deaths later, the suicide rate hasn’t improved. The number of suspected suicides in 2012 among active-duty soldiers was 166 at the end of October, surpassing the 165 total for all of 2011.
What’s gone wrong? Why hasn’t the Army or Defense Department been able to reduce the number of suicides?
Experts say it’s because efforts have ignored the most evidence-backed, proven prevention method: making suicide harder by restricting access to lethal means.
“There are two ways to reduce suicide: You can make it harder for them to die in an attempt, or you can heal underlying distress,” said Dr. Matthew Miller, the associate director of the Harvard Injury Control Research Center at the Harvard School of Public Health.
“The idea is to restrict methods that are the most lethal, to provide a second chance,” Miller said.
“Means restriction,” as it’s called in public health, has been proven to reduce the suicide rate in a wide variety of places.
In 2006, after years of suicides among young men in the Israel Defense Forces, authorities forbade the troops from bringing their rifles home on weekends. Suicides dropped by 40 percent, according to a 2010 study by psychiatrists with the IDF and the Sheba Medical Center.
Those attempting suicide for the most part act on impulse, often after surprisingly brief periods of deliberation. But the impulse also passes. A survey of people who deliberated about killing themselves but did not act found that for about half, the suicidal period lasted less than an hour, according to Miller.
Among people who made near-lethal attempts, 24 percent took less than five minutes between the decision to kill themselves and the actual attempt. Seventy percent took less than an hour, according to a 2001 University of Houston study of 153 survivors.
Although people who attempt suicide often suffer from psychological distress, Miller said, they don’t act until a “last straw” — a loss, a humiliation, an arrest.
“That’s the time when you can lose control of your ability to act in a sensible way,” he said. “When you are at your wits’ end, what you can reach for determines whether you live or die. All you have to do to die is lose control for one minute.
“If you’re in a house with a gun, there’s a lot more of a chance you’re going to die,” he said.
Living in a home with a gun increases the suicide death risk two- to 10-fold, Miller said.
Firearms were used in 68 percent of Army suicides in 2010, according to an Army Health and Violence report released this year. Most often, soldiers shot themselves to death at home or in the barracks.
By comparison, more than half of suicides by U.S. civilians annually involved firearms, according to data from the Centers for Disease Control and Prevention.
A matter of rights
As the Army’s vice chief of staff from 2008 until he retired in March, it was part of Gen. Peter Chiarelli’s job to try to reduce the suicide rate. After reviewing hundreds of suicide reports, the conclusion was inescapable, he said in a recent interview with Stars and Stripes.
“There’s nothing worse than the abuse of alcohol and the ability to get your hands on a weapon,” he said.
Drug overdoses, by comparison, were far less lethal, causing only 4 percent of suicides and 56 percent of suicide attempts.
It was another statistic that most confounded Chiarelli: Half the soldiers who killed themselves had not slipped under the radar or avoided professional help. They’d seen a mental health provider, whether it had been six months or six hours before the suicide.
“In the four years I was vice — in all four years — between 49 and 51 percent had gone in to seek help,” said Chiarelli, who now heads a Seattle nonprofit brain-injury research organization called One Mind for Research.
In each case, a presumably well-intentioned social worker, doctor or other expert had written on these soldiers’ records: “Not a danger to himself or others,” Chiarelli said. “That just drove me crazy.”
About two years ago, Chiarelli read a medical journal article sent to the Pentagon’s upper echelons by Adm. Mike Mullen, then chairman of the Joint Chiefs of Staff. The article described how voluntary means restriction in a group of people with an extremely high suicide risk had reduced the suicide rate — to zero.
Chiarelli wanted to try it.
“Quite frankly, all I was trying to get done was the ability of our folks to ask the (potentially suicidal) person about his weapons and make a recommendation that they would separate themselves from the weapon — turn it in, give it to a friend — until the suicidal feelings passed.”
But it wasn’t possible.
“I was told by my lawyers that even that would cause issues,” Chiarelli said. “I was told there would be huge problems with the NRA.”
Commanders typically disable or take the firearms of deployed troops identified as potentially suicidal, but they do not have that authority with private firearms kept off base.
Last year, the National Rifle Association successfully lobbied Republican legislators to include in the annual defense authorization bill a measure barring commanders from collecting information about troops’ personal weapons. The law was widely interpreted to mean that commanders could not ask about the weapons or suggest they be stored elsewhere. The NRA said it was defending Second Amendment rights.
“I think it’s ridiculous,” Chiarelli said. “Nobody was infringing on anybody’s Second Amendment rights. We weren’t going to go out to their house and confiscate weapons.”
Last week, Chiarelli was joined by more than a dozen senior retired generals and admirals who sent a letter to Congress to amend the law they said “dangerously interferes” with the ability of commanders to help troops, according to The Washington Post. “The law is directly prohibiting conversations that are needed to save lives,” the letter said.
Sen. John Kerry, D-Mass., was trying to add language amending the law to the Senate version of the 2013 National Defense Authorization Act bill, the Post reported Monday. The House version of the bill that amends the law has already passed, the Post said, and authorizes mental health professionals and commanding officers to ask servicemembers about firearms and ammunition when they believe them at risk for suicide.
Legislators have said that this year they’ll clarify the law so that commanders, as well as other “gatekeepers” such as chaplains and doctors, are allowed to discuss weapons if they have “reasonable grounds” to believe the person is at high risk of committing suicide or harming others. There has been movement within the Defense Department to suggest voluntary means restriction to troops.
The Pentagon has helped hand out more than 65,000 gun locks this year. In a planned safety campaign, troops and their families will be reminded that they can store personal weapons in the base armory, and that it’s never a good idea to store weapons with ammunition.
Plus, a “working group focused specifically on means restriction” will brief a General Officer Steering Committee, according to DOD spokeswoman Cynthia Smith.
The Defense Department and Department of Veterans’ Affairs are working together on joint clinical practice guidelines for suicide that will include means restriction and “safety planning,” Smith said.
Means restriction remains little understood in many parts of the military, or as a former Army psychiatrist said, is politically “the third rail.”
“It’s definitely not popular to talk about restrictions on firearms in the military,” said Lisa Jaycox, co-author of a recent RAND Corp. report for the military on suicide that recommended means restriction among other methods. “It goes against the grain of the institution.”
A 2008 New England Journal of Medicine article by Miller and his associate David Hemenway said many U.S. physicians are unfamiliar with the evidence linking guns to suicide and believe that anyone serious enough about suicide to use a gun would find another equally effective method if the gun weren’t available.
“This belief is invalid,” the article states.
Army psychiatrists and other medical providers are on the front lines of those charged with keeping troops from killing themselves. Yet, an Army Medical Command spokeswoman said the command had nothing to say about means restriction.
“In Army Medicine, we deal with those aspects of suicide as it relates to a Soldier’s mental health, not as it relates to their access to weapons,” she wrote in an email.
The spokeswoman referred questions to a spokesman for the Army Suicide Prevention Program, who did not respond to emailed questions.
Jackie Garrick, acting director of the new Defense Suicide Prevention Office at the Pentagon, said the long-standing prevention emphasis on suicide awareness, caring and treatment remained key. She said many soldiers, if they didn’t have access to a weapon, would use some other method.
“I think means does matter,” she said. “But what we want to do is get to the problem before they get to a tipping point.”
“We need to know our troops at the command level,” she said. “We need to engage leadership and families. We need to back up the mountain instead of just worrying about the firearm.”
In 1999, the Army devised a suicide prevention campaign plan that said many of the same things, including the need to “destigmatize” mental health care.
“Although our first line of defense will be our soldiers, peers or battle buddies, truly our most valuable player in suicide prevention will be the first line supervisor,” the plan said. “They must be able to recognize serious personal problems … must make the time to really learn about their soldiers, including their personal life … be trained to recognize the symptoms of serious mood disorders … and have a genuine concern for the overall welfare of their soldiers.”
Civilian suicide prevention plans also have called for communities to offer more connectedness and compassion. Feeling connected to other people is protective against suicide; a more compassionate society or Army seems like a worthy goal.
But it’s not a strategy, Miller said.
“It’s not useful. It’s not actionable,” he said. “The question is, ‘What can you do?’ Not how do you restructure society.”
Col. (Ret.) Elspeth Cameron Ritchie, a psychiatrist and former adviser to the Army surgeon general, said that despite best efforts troops have had largely negative experiences with seeking military mental health treatment, which, she said, they find “humiliating.”
“Going into the waiting room, sitting there for an hour — soldiers hated it,” she said. “Having people see them, they hated it.”
Seeking help might be a sign of “strength,” as the Army is trying to convince soldiers, but Ritchie said the process isn’t a good fit with a lot of young men; they don’t want to sit around and discuss their feelings.
“What hasn’t been tried is gun safety,” Ritchie said.
She said that two-thirds of suicides happened not on deployment but at home, most often on bases with high operations tempos.
But Fort Drum, in upstate New York, was an exception.
“New York has restrictive gun laws,” Ritchie said. “So, it’s not so easy to get drunk, get a gun and shoot yourself.”
According to a July 2012 story in USA Today, soldiers at Fort Carson, Colo., who had attempted suicide listed 10 reasons on average they’d tried to end their lives, including psychological pain, chronic sadness and desperation.
They didn’t want to die, said Army Col. Carl Castro, coordinator of $50 million in suicide prevention research and treatment as head of the Military Suicide Research Consortium, which did the study. They wanted, he told the newspaper, “the pain they’re currently in to stop, and they don’t see any other way out.”
The Fort Carson study showed that instead of trying to treat underlying illnesses such as depression, the Army should “teach soldiers skills at quelling emotional pain,” the story said. How to do that wasn’t discussed.
The same group — The Military Suicide Research Consortium — in a July report to Congress on best prevention practices noted that there was little evidence of the effectiveness of most prevention methods. Means restriction, the report said, was “a particularly important and effective strategy” and had been shown to reduce overall suicide rates.
“Specifically, suicide rates have decreased following firearm control legislation; detoxification of domestic gas; restriction on barbiturates; alteration of the packaging on analgesics; construction of bridge barriers; mandatory use of catalytic converters in motor vehicles; and the use of lower toxicity anti-depressants,” the report said. “Studies demonstrate that method substitution is rare.’’
In the U.S. — not only in the military — the suicide prevention focus has been on discussing risk factors and asking family, friends and others to spot pre-suicidal behavior and get troubled people into treatment.
Most people who try to kill themselves “usually tell someone,” according to an Army website dedicated to suicide prevention.
Research doesn’t support that. Almost 70 percent of soldiers who killed themselves and nearly 90 percent of those who attempted to “did not communicate their intent,” the Army health and violence report says.
Why the Army rate increased over the past years remains unclear. Stresses from deployment, the operations tempo and surge-related recruiting standards are all thought to play a role.
In 2010, 54 percent of troops who committed suicide and 59 percent of those who attempted had not deployed, Army Secretary John McHugh told reporters at a September press conference, according to the Army Times. Eighty-nine percent had not engaged in combat.
More than 90 percent of people who survive a suicide attempt do not go on to kill themselves, according to a 2002 review of 90 studies published in the British Journal of Psychiatry. That held true even when people who had attempted suicide were followed for a decade and for those who used lethal means, such as jumping in front of a train or off a bridge or using a gun, Miller said.
Some 20 percent made another nonfatal attempt, Miller said. About 70 percent made no further suicide attempts.
“There’s lots of opportunity to act,” Miller said. “If people are struggling, if they’ve had setbacks like divorce, arrest, financial troubles; if they’ve stepped up drug and alcohol consumption; if they’re not sleeping or are having mood swings or feel despair …
“Why not have the conversation?” Miller said. “To respectfully involve them in a discussion so that they can act in their own enlightened self-interest and in the interest of their families and the people that they care about, to temporarily remove the gun?”
Miller said troops could decide to make a “Ulysses contract,” named for the Greek warrior who spent a decade in the Trojan War. While on his voyage home, Ulysses avoided being called to his death by the enchanting voices of the sirens who lured sailors to shipwreck.
“He wanted to hear the sirens,” Miller said. “He bound himself to the mast so he couldn’t act.”
Workplace violence
The U.S. is becoming a third world “mess”, very quickly. Sadly, way too many people continue to not see it, as it happens.
The soldiers are responding to the fact that they are
being forced to operate under conditions that no sane
person should be forced to endure. The response to such
folly is predictable and it includes suicide.
The solution to the problem is simple. Give the soldiers
a clear concise goal to achieve....remove ALL restrictions
on achieving it then bring them home. It’s just that simple.
The soldiers are responding to the fact that they are
being forced to operate under conditions that no sane
person should be forced to endure. The response to such
folly is predictable and it includes suicide.
The solution to the problem is simple. Give the soldiers
a clear concise goal to achieve....remove ALL restrictions
on achieving it then bring them home. It’s just that simple.
Helping to wind up the Obama gun grab agenda.
While we’re at it, let’s reduce bartenders’ access to alcohol to reduce drunkenness and doctors’ access to drugs to reduce addiction.
Tobacco? No.
Marijuana? Yes.
Cocaine? No.
Money? Only what The State allows.
We should also, of course, reduce runners’ access to roads to reduce their involvement with their endorphins and eliminate sex to reduce partners’ fixation on their pleasure centers, and, for that matter, we should eliminate or reduce any and all behaviors of which our government nannies don’t approve.
It’s not that Big Brother’s a fascist at heart, he’s just a busybody with a compulsion to stick his long nose into everyone else’s business, and has nothing valuable to do with his time.
Ping
Who are the LAST group of people our insurgent government would want carrying weapons when the they drop the hammer and the rebellion starts?
Now that you mention it, there’s a sudden barrage of gun ban talk immediately following the election.. And no, the football player incident isn’t the reason for it. The media seized upon it to further a top priority in the King Kenyan’s second term.
Did I red this right? It said only 11% of suicides were by active duty men who had seen combat. If that is true, doesn’t that fly in the face of what everyone (the media etc) is trying to imply?
I see the as using a so-called mental health issue to paint our servicemen with a very broad brush and further marginalize them.
We don’t let soldiers vote.
Why would we let them carry guns?
More to the point, they’re trying to establish a basis for denying firearms to anyone with the training to actually use them.
Before it’s over, you’ll see military service as a disqualifier for having a carry permit.
Restrict the Kennedys' access to cars first, and then you can worry about firearms.
Bodies on three fronts of WW2 are littered with suicides.
And WW1 and Roman wars etc. etc. God sorts them out.
This guy is just trying to justify his job at Harvard. Here is information from their website:
Harvard Injury Control Research Center
Firearms Research
To read about HICRC Firearms Research please see the list on the left hand side. There are 20 topics to choose from e.g. Homicide, Suicide, Homicide followed by Suicide, Accidents, Children, Women, Gun Ownership, Gun Storage, Guns at College, Gun Threats and Self-Defense Gun Use, Batters, Gun Carrying, Road Rage, Other Countries, Policy Evaluation, Public Health Approach, Public Opinion, Surveillance and Data Quality, Miscellaneous, and Overall.
RECENT PEER-REVIEWED PUBLICATIONS
A full list of HICRC journal publications (firearm and nonfirearm) organized by year is available under Publications. Journal articles specific to firearms research are also organized by topic— see the sub-menu.
FIREARMS RESEARCH DIGEST
In 2010 HICRC launched the Firearms Research Digest, an online database providing short summaries of academic research on firearms. The database is user-friendly and updated with additional years regularly.
******************************************************
In research studies you try to look at the change in variables that correlates with the change in observed result. The suicide rate for active duty soldiers has been approximately half of the suicide rate of the same age group in the general population. Since Obama took office and changed the rules of engagement, the suicide rate among active duty soldiers has nearly doubled and is now approaching the general population rate.
These soldiers have always had guns, they haven’t always had Obama and his silly rules of engagement. Change the variable that correlates with the increase in suicides in the military!
Yep
Since Obama took office and changed the rules of engagement, the suicide rate among active duty soldiers has nearly doubled and is now approaching the general population rate.
In context, the cause becomes clear, and the magnitude of the problem is placed in perspective.
Don't look for the gun grabbers to do that.
The one place that weapons should be removed temporarily is in the Warrior Transition Program where soldiers who are having trouble adjusting to society after severe combat and PTSD. They cling to their guns like a child does its security blanket. This is not a bad thing in of itself, however it is indicative of their level of PTSD. Many of these soldiers are housed off base and end up getting in a “situation” where they are killed, wounded, incarcerated, and/or dishonorably discharged. The problem is not the gun, but having it while they have severe PTSD creates big problems.
One problem is, when an individual is labeled by their psychiatrist as not being able to have a weapon due to mental status, that label carries with them in their future lives. Many of these wounded soldiers would heal their PTSD far faster in properly supervised group programs on base/ or with virtual reality programs.
The transition must be made for these wounded soldiers to be in an environment where they learn to trust the people around them more than they trust their guns. When this is accomplished, give them back their guns. If the transition is first done in an environment with other soldiers, then family and then slowly integrate society, the healing will accelerate.
I say these comments as a close friend is now in prison facing 15 counts of attempted murder after firing his gun in his off base apartment while in the Warrior Transition Program. He was under many, many medications including pain killers as he was recovering from recent back surgery. He was in his third tour as a S.Sgt. and had a lot of combat involvement. While asleep in his apartment at night, a local fireman tried to smash his apartment door in due to a small fire outside the complex. He awoke to the crashing sounds, thinking he was back in Afghanistan and the insurgents were attacking. The swat team arrived and shot him four times, twice in the face.
It’s pretty easy to see that he never should have been living off base alone while undergoing PTSD treatment, and being drugged up with pain killers from surgery.
Since this event, which was earlier this year, the Army has reviewed and changed many of the treatment methodologies, including restricting prescribing benzos, which were determined to cause more harm than good.
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