Webinar: Veterans, Military Personnel, and Suicide Prevention
Webinar Description: The Veterans, Military Personnel, and Suicide webinar was
presented by John Rodolico, Ph.D., Director of Adolescent Addictions Training at
McLean Hospital/Harvard Medical School. This webinar outlined the recent trends of
suicide in the military and present techniques and policies used in the past and present
showing how the military has adjusted to the recent increase in suicide. Included in the
webinar will be a discussion on how to recognize the signs of suicide not only with
military personnel but also returning veterans including National Guard and Reserve
soldiers. Finally, there was a discussion about the military culture and the work being
done to remove the stigma of getting help.
Webinar Duration: Approximately 90 minutes
Brandy Brooks: Good afternoon and welcome to the Veterans, Military Personnel, and
Suicide Prevention webinar. My name is Brandy Brooks and, aside from being the
moderator this afternoon, I am a Contract Manager for the Massachusetts Department of
Public Health Suicide Prevention Program, the sponsors of this webinar.
Before I introduce our presenter, Dr. John Rodolico, I would like to go over a few
housekeeping issues. First, should anyone experience any technical difficulties with
either the audio or video for this webinar, please dial 1-800-843-9166. Again, that’s 1800-843-9166 and a ReadyTalk representative will be more than happy to help.
Second, all telephone lines are muted except mine and Dr. Rodolico’s so please use the
chat function located in the left corner to type in any questions you may have. Given the
number of participants, Dr. Rodolico will do his very best to answer as many questions as
possible as we go along and at the end of the webinar during the question and answer
period.
Now that I’ve gotten that out of the way, let me introduce our presenter, Dr. Rodolico.
Dr. Rodolico is Director of Adolescent Addictions Training and Director of Military
Consultation Service at Mclean Hospital. Dr. Rodolico’s pre-doctoral internship at
McLean Hospital has been involved in treating adult and adolescent substance abusers
with co-occurring psychiatric disorders. For the past 25 years he has supervised,
consulted, and mentored numerous young clinicians in this area, along with trying to
advance the treatment acceptability for this population.
His major interests are uncovering the motivation for drug use among teenagers and how
to use this motivation in a treatment arena. Currently, he is the Clinical Supervisor for
two post-doctoral candidates who are working in the Child and Adolescent ART at East
House and The Landing where he also serves as the Director of Adolescent Addictions
Training.
On the adult side, he supervises the Addiction Psychiatry Fellows at McLean Hospital to
help better integrate addictions and adolescent training. Dr. Rodolico’s more formal
instruction occurs at several sites; at the Massachusetts General Hospital, where he does
an annual six-week seminar on the assessment and treatment of adolescent substance
abuse for the Child and Adolescent Psychiatric Fellows in the McLean MGH residency
program. He also co-leads a weekly Milieu seminar for all child and adolescent trainees.
As well, over the past two years he has developed a 16-hour training in motivational
interviewing for staff, residents, psychology interns, and post-doctoral candidates.
Dr. Rodolico’s classroom instruction has spanned 16 years at Middlesex Community
College where he teaches Introduction to Addictive Disorders Basic Counseling Skills.
As well, he works with the Boston College Graduate School of Social Work where he
teaches Treatment and Addiction. He has also had the privilege of being on dissertation
committees for students who are doctoral candidates in clinical psychology. These
committees were at Northwestern University, Antioch New England Graduate School,
Massachusetts School of Professional Psychology, and Boston University.
Dr. Rodolico has been consistently involved in the training of mental health officers and
combat medics as an officer in the United States Army Reserve. This training ranges
from one-time briefings to formal trainings that last over a three-month period of time, in
the U.S. and the Middle East. The highlight of his military career so far was serving as
the Executive Officer of a combat stress company, deployed to Iraq in 2003 and 2006.
During that time, Dr. Rodolico helped redesign the delivery of mental health care to
soldiers and Marines in the Sunni Triangle of Iraq.
This experience has carried over to his present clinical work at McLean, where he leads a
workgroup focusing on the reintegration of new veterans into the healthcare system. He
has also given numerous in-service presentations at the hospital to raise the consciousness
of the staff and faculty about this new generation of veterans.
In summary, Dr. Rodolico has 31 years’ experience working in the mental health
addiction field and has seen many people battle addiction in many ways. His research
curiosity and clinical interest are geared towards taking evidence from clinical research
and translating it into clinical practice for all clinical settings.
So, without further ado, I will now turn it over to Dr. Rodolico. Dr. Rodolico, are you
there?
John Rodolico: I am here. Can you hear me?
Brandy Brooks: Yes, I can.
John Rodolico: Okay, good. Thank you everybody for joining us. This is the first time
I’m doing one of these so if I fumble through some of the technology, I apologize. I like
this technology but sometimes, when it’s new to me, I do fumble around a little bit.
I will be checking the chat box for your questions. I do want this to be more of a
workshop mode than a straight lecture or briefing because this is a topic that -- I think I
want to add to that really great introduction -- but I do want to add this is a topic that I’ve
grown more and more passionate about, really, since my second deployment to Iraq
which was a little over four years ago. Thanks for inviting me and hopefully we can have
a good dialogue about this very, very important topic that’s getting more and more
important every year.
It is a little unusual doing a webinar, being that this is my first one. Usually I can look
you in the face and I could, at this point, ask if there are any veterans in the audience. If
there are veterans in the audience or service members, thanks for your service. We’ll
move on from there.
Some of the objectives that I’m going to want to look at here -- let’s see if I can advance
this. Can everyone see the screen okay?
Brandy Brooks: I can see it. You’re okay.
John Rodolico: That advanced okay?
Brandy Brooks: Yes, it did.
John Rodolico: Some of the objectives we’re going to try and cover here; I’m going to
go over the demographics because I think you can’t understand the breadth of the
incidence of suicide in the military without understanding who this new generation is of
veterans. I’m going to go over that a little bit and spend a lot of time on that to introduce
you to this new generation because, if you saw me, I am an older soldier and I’m not the
typical veteran. I also work in a major teaching hospital. The typical veterans don’t come
back to that and the typical veterans are not my age but I’ll go over some of the
demographics of that.
I’m going to go over something called the Mental Health Advisory Team. This is a study
that’s been going on for the past seven years. It started in the Iraq conflict, when the Iraq
conflict started in 2003. It carried over and now it has transferred over to the Afghanistan
theatre. I’m going to go over maybe some other major military studies from 2003 to 2010
and actually I have one on my desk now from 2011 that I’m probably going to mention.
The biggest thing I want to go over also, in these objectives, is the military culture and
what the military culture is and how it impacts suicide. I think this is something that
doesn’t get written about a lot in the suicide literature but it is something that is worth
discussing.
Of course, finally, the military interventions that are being done these days. I should say
right up front, the military has been wrestling with this issue for many, many years. I
know General Casey, the former Chief of Staff of the Army, has made it his own personal
project at this point. I want to talk a little bit about some of the new interventions that we
have going in the military. Then, of course, discussion throughout so I will continuously
be looking at this box here to see if I can get to some of your questions.
Without further ado, let’s move on to another slide. Again, you can’t have a discussion
about military issues without using acronyms. So, what I do when I give these talks is I
give you a little cheat sheet with all the acronyms that I might have in my slides; OIF,
Operation Iraqi Freedom; OEF, Operation Enduring Freedom. Operating Enduring
Freedom is Afghanistan. We’re going to talk a little bit more about the Mental Health
Advisory Teams, that’s the research team that’s boots on the ground. Forward Operating
Base is basically a base where most of the military gathers or where they live and then
they go out on patrol from there. AC is simply the Active Duty. These are the guys who
are full-time military. RC, Reserve Component, and I’ll explain what Maneuver Brigade
and a Sustainment Brigade is.
Who is this new generation of veterans? One of the things that I do with -- you can see on
this slide here it says new generation of veterans -- one of the things that I do with a live
audience that I really can’t do here but what I do is I ask the audience to actually picture
five Marines coming back from Iraq or Afghanistan with M-16’s wrapped on their
shoulders. Most people will picture a bunch of men. Then I put this up and I show the
five women that you see standing there who just got off their bus in California after
spending a tour in Iraq.
This is a new generation of veterans that we’re seeing. It’s very important that if you're
going to work with veterans in any way, whether it be with suicide prevention, PTSD,
depression, or substance abuse that you really understand what the characteristics and
what the differences are between this generation and past generations of veterans. One of
the things that I know adds to the stigma or to the rejection of treatment is that people
will lump all the veterans together.
Who are these folks? Let’s just go over how many people have been deployed. Presently,
there have been 2.2 million soldiers and Marines deployed to Iraq and Afghanistan. Some
numbers here about this; if you’ve been following this at all you know that the really
good news that all of us received about a month ago is that we’re going to pulling most of
troops out of Iraq within a month, at the end of this month which is going to bring our
troop rates very minimal into that theatre. At one point we had as many as 164,000 troops
in Iraq. In the beginning of that war we had as many as close to 200,000 over there. So,
that’s quite a big deal that’s going to occur on the 31st or before the 31st.
Unfortunately in the other theatre, our rates of troops have gone up and now they are
close to around, the last figure I saw was around 83,000 troops are in Afghanistan. Again,
there are all kinds of benchmarks as to when they're coming back.
The other statistic I want you to look at is the gender difference. You can see that it’s
85% male, but 15% female; that is one of the highest percentages of women in a theatre
of war, in a combat theatre. The other thing I say when I talk about this new generation is
women are doing more and more of combat jobs; that is they're not only nurses or clerks
or something like that that you see in the movies all the time. The women in these
conflicts are convoy commanders. They're squad leaders. They're right out there. They're
putting themselves in danger. They're signing up for dangerous jobs. That’s something
that’s very different and very, very different with this new generation.
78% of the fighting forces between 18 and 30. Again, this is a young group we’re talking
about. When we get into the nitty-gritty of the suicide issue and if you’re a suicidologist
and you study suicide a lot you know that that age group, typically 18 to 25, is a high,
high risk age group, particularly males. The remaining 22% are over 30.
51% of soldiers are married, 45% having children. Again, very different with this
generation, that this generation of soldiers and marines are married, slightly more than a
majority are married. That’s very unusual than in the past. Not only are they married but
almost 50% of them have children. Something else that’s very, very different from this
generation.
35% of the deployed soldiers are Reserve Component; again, very, very different. If
anyone is from the Vietnam era, you might remember that if you were in the National
Guard or Reserve Component you probably weren’t going to go to Vietnam. That’s very
different in this conflict. In fact, Reserve soldiers are used a great deal. At one point, I
think in 2004, almost 50% of the fighting force in Iraq was either National Guard or
Reserve. So the Reserve Component is being used a great deal which does impact
treatment, when they come home, in a number of ways.
Education; you can see two numbers on your slide. The first one is -- what I’m doing is a
slight comparison where I first started giving talks about suicide in the military or PTSD,
any kind of military talk and really kind of wrapping around this new generation of
veterans that we have here. That first number indicates what the number was back four
years ago. So, 45% had a high school diploma or a GED; 43% now. Some college or
Associate degree, again, that went down, 46% to 44%. What’s encouraging though is that
four-year degree number -- I’m just looking at the note that just came through -- that
four-year degree is very different. You can see that more people are getting their college
degrees at this point. Someone just wrote in and I’m going to actually try and address this
when I get finished with these statistics. Graduate degrees are 1%. There was no change
there.
More about this new generation; most soldiers, soldiers and Marines, they joined after
9/11. They knew they were going to get deployed. They also knew they were going to
deploy more than once. They grew up in a very, very highly technical society so they're
very good at the gadgets that they're giving to them in the military and actually they're
very well-trained. The training in the military right now in this generation is boasted not
just by military officials, not just by people living in the United States, but people from
other countries look at our military and they look at our training and it is really the best
training that’s been afforded to any personnel, really, in our history at this point. This
new generation has had tremendous training on all the different equipment and in very
different ways.
Now, I should add, they're getting trained in mental health interventions. Every soldier
right now, which I’ll get into when I talk about Comprehensive Soldier Fitness later on,
every soldier right now is being trained in mental health issues.
The other thing that’s different between, definitely through the Vietnam War, is there’s
tremendous support from the civilian population. This support, you can see all the time.
One of stories I tell is the first time I came back from leave, that was around 2006, the
first time I came back from leave I had to layover in Atlanta airport and I was exhausted
after flying for about 22 hours. You go from Baghdad down to Kuwait and then over to
Atlanta from there so it’s quite a long flight and there’s a layover in Ireland somewhere.
You’re in the air for about 22 hours and you're exhausted and I came home and there was
a stream of Vietnam veterans there welcoming us as we came off the plane from leave. It
was, to this day, one of the most touching moments I’ve had in my life; just seeing that
kind of support. Any time you go into an airport when you're in your uniform, the support
is just unbelievable. I think that’s very different that this generation is seeing the support.
What I’ve heard from some of the younger guys is they don’t have comparison group, the
way we would talk about it in research terms. I do have a comparison group because I am
at the edge of the Vietnam era. That’s just a real plus for this new generation.
The other thing that’s different in this conflict that’s very different than other conflicts is
there’s a 360-degree battlefield. The psychological impact of that is tremendous on these
young men and women who are over there. What I mean by 360 degrees, it means that
there’s no front line. Most theatres of war, there’s a front line, then there’s a retreat line
and then there’s actually what we call the rear where all the supply is.
When you go into the Iraq or Afghanistan theatres, you’re not going to find those lines of
battle, if you will. In this theatre, there’s a 360-degree battlefield, meaning that, quite
frankly to put it simply, that you’re never safe. So, somebody could never come off the
FOB, that Forward Operating Base which is a protected area but you're really not
protected because of mortars, IED’s, and rockets, and things of that nature or car bombs.
That’s very different in this theatre.
The other big impact is a widespread use of IED’s, improvised explosive devices, and
other explosives. Explosives are the primary weapon of the enemy over there. That’s one
of the biggest problems that people are facing. The injuries that are caused by them are
tremendous.
One of the other psychological impacts, of course, is the interruption of careers,
education, and family. Careers get interrupted all the time because of deployment. Mostly
now I’m talking about Reserve, National Guard Components. Somebody could be in their
career as a security officer, a policeman, a teacher, what have you and they're moving
forward in their career and then, all of a sudden, they get deployed and their career gets
put on hold.
Also, with education; a lot of times one of the stories I tell sometimes about education is
that I knew a young man that I was deployed with twice in 2003 and 2006. It took him
eight years to get a four-year degree, not because he was a difficult student. Actually, to
tell you what kind of student he is, he right now is at Penn State in their medical school.
He was a very, very good student but it took him eight years to get a four-year degree.
That’s an example of how education gets interrupted a lot. That definitely has a
psychological impact on people.
You see the bottom bullet there that says better communication. You think intuitively;
how can better communication have a negative psychological impact? One of the things
that we noticed was that the more people spoke to their family, that wasn’t necessarily a
good thing because you felt really like you were between two places; that you couldn’t
intervene at home because Johnny wasn’t doing his homework or he missed his father. At
the same time you had this very, very, very important job to do in Baghdad or Kabul or
one of the bases that you were at. Better communication was not seen as a good thing
and, actually, it was seen as a stressor by many, many soldiers.
Before I move on to boots-on-the-ground research, I do want to get to this question here.
The question is from somebody who is a suicidologist, so that’s great to have you in the
audience. The question is, “Suicide season is March through May. Is it different for the
military?”
Well, it’s different in that it doesn’t follow the month. I actually have a graph coming up
in about five or six slides forward and I will speak to that a little bit. It does have a
pattern to it but it’s usually the length of their deployment, at certain months in their
deployment, that that happens. Thanks for that question and I’ll try and be as sharp as I
can with paying attention to these questions.
Boots-on-the-ground research; what this is, there’s not a lot of research, boots on the
ground -- what I mean by boots on the ground by the way is that in theatre, in Iraq, in
Afghanistan that we’re doing research on the soldiers, asking them questions while
they're over there. What the Walter Reed group did, the research group down at Walter
Reed, was they came up with the Mental Health Advisory Teams. What these teams were
is a team of military officers, mental health officers, one led by Colonel Carl Castro
who’s a leader in military psychology and psychiatry. He took a team over there in 2003,
travelled to the Iraqi theatre and now they’re travelling to the Afghanistan theatre to
really just assess the current behavioral health of soldiers to get a real dipstick on; what’s
going on with these young men and women while they're in theatre? That’s how they
came up with the Mental Health Advisory Team.
It not only examines what the mental health is of the troops over there but it also spends a
lot of time, particularly in the more mature surveys of the past three or four years, is;
what’s going on with the delivery of the behavioral health care over there? Are soldiers
getting to the care they need? Is the care available? Who’s getting the care? Of course
they analyze the information obtained and they provide the recommendations.
These are just some of the findings and I’m going to update the findings with the latest
one. Of course, just like all research, this a couple years behind but I have the 2010 one
so I’ll try and add to that in a second. I want you to pay attention to the right of this chart.
As you see, Maneuver and Support & Sustainment. You can see there’s a significant
difference between combat exposure and that makes sense because Maneuver units are
the units or the guys that are kicking in the doors, that are shooting at the bad guys, and
getting shot at.
The Sustainment people are more people who are medical officers or medics or mental
health people, finance people, supply, and on and on. It’s just like it says there Support &
Sustainment. They sustain the fighting force where the maneuver units, those are the
groups that go in and maneuver or get to the enemy.
You can see that combat exposure between OEF which, again, is Afghanistan has a rate
has gone up from 2005. You can see it’s slightly dropped in Iraq. Actually, that’s going
to drop. In 2010, that drops to about 5, number of combat exposures. So, that drops way
down with Iraq. The recent numbers for Afghanistan have held stable. I think it went up
to about 15 or maybe 15.1, that’s combat exposures. It’s important to keep that in mind
because one of the things that we always think about is the more combat exposure, well
then the more stress-related illnesses and suicide, again, would be one of those that get
impacted.
Here we have psychological problems and notice, again, to the lower right of this chart. If
you notice the Sustainment folks, there’s no significance between the two. I always found
that quite interesting. That plays into this 360-degree battlefield. Nobody is immune to
combat stress. That was very important for leaders to know, combat stress people like
myself to know, but also very important for civilians who, when they hear, “Well, so and
so was medic or so and so was a nurse. They didn’t really see much action.” This kind of
bears out that’s not necessarily true. They're very much exposed to combat stress stigma
over there. Overall, any psychological problems, you can see how it’s starting to drift
down. Again, these numbers are from Iraq. The Afghanistan numbers are a little bit
different.
The effects of multiple deployments, you can see the difference here. NCO, I don’t know
if that was in your acronym chart there, the chart on the left is the NCO’s, any
psychological problems. Those are basically the sergeants; staff sergeants, and sergeant
first-class, and first sergeants. These folks, you can see that third deployment really does
boost it over.
One of the things that we’ve known from this data is that the third deployment could be
any kind of deployment. In other words, it doesn’t have to be three deployments to Iraq.
It could be a third deployment to Bosnia. It could be a third deployment to Kuwait. It
could be a third deployment to, even, Germany. It’s just that third time of being away
from your family for, let’s say, over six months up to a year. That’s what those numbers
are representing.
Marital problems, you see the same thing. First and second deployment. Third
deployment, again, you can look at that. It almost triples and more than doubles which is
an interesting phenomenon that between the first and second deployment, you don’t see
any increase in marital problems but you do see an increase, like I said, a great increase
in the third deployment. Again, one of the things I’ve learned over the years is that that
third deployment can be any kind of deployment at all.
I’m going to try and get some questions here. The first question is, “What are the total
number of people polled and who compiled the data?”
The data was compiled by that Walter Reed group, led by Colonel Carl Castro, and his
group down at Walter Reed. I do have the sample numbers here. The n in this sample that
I’m talking about now, this last sample, was 911 service members.
The second question, “Are these numbers from 2009?”
The numbers that you’re seeing in the slides are from 2009 because I actually have the
numbers from 2010, which just came out, right in front of me. I’m going to try and
augment those as much as possible.
Thanks for asking these questions, though, and I’m going to try and stay alert to them.
So that’s the marital problems -Yes, these slides will be available. They will definitely be available after this. “Is there a
way we can get the 2010 numbers?” Absolutely. I will actually send you the document
when I send the slides that I’m going to be augmenting with so you can read that
summary yourself. Thanks for those questions.
Next slide is OIF suicide rate. You can see the suicide rates and the difference in the
theatres. The suicide rate, you can see that there’s something within 2004, we think that
might be, actually, a sampling error in 2004. That’s why the suicide rate drops so much.
However, we’re trying to figure out why that dropped so much there. The other
interesting thing in 2004 with the population is, that was the year where there were more
National Guard and Reserve people in the theatre of operation.
You can see that the suicide rate continues to climb. The suicide rate, unfortunately, since
2008 has climbed even higher. It’s at 26.2 right now which is a very high rate of suicide
in theatre. The suicide rate, what’s really climbing, which you hear about in the media all
the time with suicide in the military is that it’s not just the rate of suicides of people being
deployed but it’s also the rate of suicide of people who haven’t been deployed. The recent
National Guard studies -- just a little aside, get just a little off the slides for second -- in a
recent tracking of suicides, there were 103 National Guard Reserve suicides last year. Of
the 103, 55 of them were from people who were not deployed, who were never deployed.
There was something else going on in the military or the military culture that might be
pushing this a little bit.
The other thing is that, in the past, the National Guard and Reserve numbers, if somebody
-- again, this is where understanding military culture is important and military traditions.
The National Guard as you hear on the commercials all the time, and Reserves, is one
weekend a month. One weekend a month, well that’s when your commander or that’s
when the Army is in charge of you is just for those two days. I’m about to do my
weekend starting in a couple of hours, actually. At that point, I am working for the
President of the United States until Sunday night. Any time in between that, my actions
or my behaviors are not the responsibility of the United States Army. The suicide
statistics then, if somebody committed suicide in between drills, well that wouldn’t get
recorded. What the Guard has started doing in the Reserve Component, is now they are
counting those in between. So, you’re going to see these spikes in the suicide rates all the
time.
I want to take a question. It’s from Jennifer Taylor. I wonder if this is the Jennifer Taylor
I know. “How honestly are the soldiers answering the questions? Do you have any way of
accounting for that?”
I don’t know how honestly they're answering the questions. That’s always a problem
actually but we’ve only got to go with what we’ve got here. I can tell you what they do is
they try and emphasize -- the confidentiality of this thing is amazing. I can tell you that
when I was over there I was in charge of -- one of our missions was to actually do these
surveys with the soldiers. It’s worse than taking a licensing exam. They're all each in
individual folders, the people sit wide apart. But, how honestly do they answer? Well,
that’s hard to tell and that’s hard to answer actually.
Theatre suicide rates, to go on to the next question, theatre suicide rates; that’s in theatre,
meaning that the suicide occurred in Iraq or Afghanistan with these statistics that’s up
there right now, in Iraq. Army suicide rate is the overall Army, anyone in the Army that
committed suicide. Those are the differences.
When the soldiers are on leave -- actually, that’s a very, very good question. The suicide
rates are from active duty soldiers not data from when they are on leave. When a soldier’s
on leave, they're still technically on active duty. So, if someone, unfortunately, committed
suicide when they were on leave, that would still count for an Army suicide at that point.
What I’m talking about is with the Army Reserves, when they're not doing their drill
status, then they are basically not in the Army at that point. They're not under the control
of the Army. Hopefully that answers the question.
Next slide; this is the theatre, again, this is in Afghanistan or Iraq. Thanks for that
question helping me clarify that. You can see the difference between the services. The
Army has the highest suicide rate; the Navy, not so much; the Marines, the second
highest suicide rate; and the Air Force, hardly any suicide rate. Again, the Army rate is
because most of the people in Iraq and Afghanistan are in the Army. The second largest
service component over there are the Marines, then the Navy, then the Air Force follow
up. That might be why those numbers are low. Here you can see the rate of suicide over
the course of years.
Before I move on, any other questions about suicide rates in theatre? Then, we’re going
to talk a little bit about; what kind of services do these guys get when they're over there?
And how are we trying to prevent suicide while they're over there? Later on, of course,
I’ll be talking about what happens when they get back.
What kind of mental health services do they receive? This is a topic that I can talk on and
on about because this is what I did when I was over there. There is something called
Combat Stress Control Units and, as you can see from the definition in that bullet, these
are units that are specialized in mental health and the key word there, by the way, is that
they're mobile. They're not set in a building. They're mobile. They're moving all the time.
They're like a mini-mental health MASH unit if you will.
They have a unique set of functional roles. The unique set is that most of the mental
health techs, not the providers, but the mental health techs are cross-trained from being
combat medics and mental health techs. They can switch roles all the time. That was one
of the interventions we made in 2006 and 2007 and by doing that we got these guys to
kind of cut through a lot of stigma and be able to get the soldiers and Marines to ask more
of our mental health teams.
Then there’s also division, brigade, battalion mental health teams also. You’ve got these
Combat Stress teams floating around all over Afghanistan and Iraq. Plus, then, you’ve got
the more stationary psychiatrists, psychologists in the division headquarters, brigade
headquarters, and battalion headquarters. Just to give you an idea; a battalion is about
1500 people, a brigade is about 3,000 to 5,000 soldiers, and a division is about 15,000
soldiers.
“Are female soldiers more likely to commit suicide?”
There isn’t a lot of numbers that are showing that, especially while they're in service. I
think the veteran numbers are going to start shifting in that way but I haven’t seen
anything that they are more likely to commit suicide. Actually, it’s mostly males that are
committing suicide.
Let me give a historical overview of these Combat Stress Units. In 2003, mental health
treatment wasn’t sophisticated. It wasn’t organized to get to the soldiers. One of things
that we ran into in 2003, which was my first deployment over there, was we were worried
that we weren’t going to have a mission. We were very, very concerned that we were not
going to have a mission when we got over there and so we really did pick up a lot of
medical missions when we were over there. Also, it was a different kind of conflict going
on. That is that there was so much action going on at that point that people couldn’t settle
down to do any mental health work.
In 2004 the reports started coming out of the theatres that there were not enough mental
health services. It turns out that were enough personnel over there but it just wasn’t
allocated in the right spot. So, what started happening was we started spreading people
out a little bit more and making sure that they got outside of these FOB’s and got to the
soldiers. By 2006, that was one of the things that my unit was integral in doing; was
pushing mental health services out to other more remote areas.
I want to try to get some of these questions. The next question is, “Is increased exposure
to violence a risk factor for soldiers and Marines?”
Yes. Increased exposure to combat is a risk for mental health issues which then could
lead to suicide so, in that sense, yes, it is. It doesn’t always have to be that way but the
numbers do mean for more exposure to combat tends to lean more toward suicide which
didn’t make sense when we look at the National Guard numbers. That’s what we’re
trying to understand right now. That’s why I’ve actually shifted my thinking that; you
know what? It might not just be the deployments. It might not be just the exposure to
IED’s and to combat. It might be something else going here that we’re not really putting
our finger on. Hopefully I’ll get to that a little bit later.
“Are officers more or less likely to commit suicide?”
There is no real significant difference between them. Actually, if anything, it’s leaning
more towards the other way, that the NCO’s and the enlisted folks are more likely to
commit suicide. Again, look at the age groups too. That’s a vulnerable age group. People
who are of the lower ranks are also the 18, 19, 20 up to 25 years old.
“Are most of the suicides happening while these soldiers are deployed or are they
happening when they come home?”
Most of the suicides that you read about are probably happening more when folks come
home only because the numbers are greater, too, probably when they come home. We’re
drawing down our troops right now so the number of suicides in theatre are going to get
less and less.
“I know in the field of suicide prevention there has been a language shift from saying
things like ‘commit suicide’ to saying things like ‘die by suicide’ or ‘complete suicide’.
Do you see a shift in best practice language also happening in the military?”
I think we’re trying to catch up with that. I think one of the things that we’re trying to do
in the services now is to try and get competencies with suicide prevention. We’re not just
kind of making it, as yet, another mission. One of the things that I was involved with this
year was a suicide task force for the National Guard. That was one of our
recommendations was that we do develop best practice, that we call in the experts from
all over the country, the civilian experts from all over the country, and get competencies
for our folks in suicide prevention and working with suicidal people.
“Are officers more education such as Air Force less likely too like regular Army?”
I couldn’t make out that question. I think, yes, officers have to have a higher education to
be an officer. You have to have at least a four-year degree to be an officer. To get
promoted, you eventually have to have a Master’s degree, to a field-grade officer, which
is a major and above. That happens across components, National Guard and Reserve.
“One in six service members are taking psychiatric medication. Are these service
members in theatre or talking about on active duty?”
It’s across all, whether it’s active duty in theatre or not. One of the things that you can see
from this slide and that is where you’re getting that from; one in six service members are
taking psychiatric meds. One of the things that happened, the second time I was over
there compared to the first time I was in Iraq, was we went over the first time in Iraq, we
basically, in the psychiatry formulary I think we had maybe three medications. One was
Ativan and the other one was, believe it or not, Haldol. There weren’t a lot of psychiatric
meds.
By the time I got there -- and it was two years later I got deployed. I got redeployed for a
second time. So, it wasn’t a long period of time. Two years later, there was a formulary
there just like I would have here at McLean Hospital or almost like I would have here,
particularly in the areas of antidepressants and sleep medications. The medications are
being used over there.
The things, of course, that aren’t being used over there are things like Lithium, Lamictal
because to have bipolar disorder you really shouldn’t be in the military. There is actually
a guideline about that. The antidepressants, the sleep medications, you can get almost any
kind of antidepressant you want while you're in theatre. They have a formulary over
there. Of course, over here you can get anything you want, too.
The other thing that’s happening, while I’m talking about that, is that a lot of service
members, because of their injuries, a lot of service members are on painkillers and we’re
starting to see a real spike in prescription drug use by service members. That’s something
that we’re putting a flag on. The reason why I mention that, too, and I have a couple
slides on this later is -- the reason why I put a flag on that is because that kind of
combination can lead to suicide, as many people know.
Once again, thanks for these questions. I’m trying to keep up to them here. If I’ve missed
your question, please send it again.
Fighting stigma; one of the things we did over there to fight the stigma was we did
something called walkabouts. What this simply means is that you go out with the troops.
Now, this is something that’s frowned upon a lot by certain commands because it really
does put your men and women in danger when they're going out with the infantry guys. I
was very fortunate because the people I was with actually wanted to do this. They were
trained to do it. We made sure they had the right training and we saw that this actually
did cut down on stigma a lot. We were able to treat more soldiers and Marines by doing
these walkabouts.
One of the other major things that’s gone on for the past four years, strictly in
Afghanistan, I just had a good friend come back from Afghanistan. He’s a psychologist
and he was a commander of Combat Stress Unit over there. He said that they're making
real headway talking with battalion commanders, who are usually lieutenant colonels and
above, about combat stress interventions and making sure that we’re force multipliers and
that we’re not going to hurt their force.
“Exactly what was done during the walkabouts?”
It was more than visual presence. What we would do is we would actually have them
become part of the team. Our techs, as I said, were cross-trained so they were medics. For
example, one of the things we did is they would go out with the EOD units -- EOD
meaning the explosive ordinance disposal units -- and they would go out and they would
be the medic for that unit. They wouldn’t be put in danger but, if anything happened to
anyone over there, they would be able to treat.
By doing that, as they're going out to do their mission, they're taking to people and also
if, unfortunately, something occurred while they were out this person is there to do the
debriefing right away. The idea with these walkabouts was that you served as a medic but
you also served as mental health consultant at the same time. They would then do the
triage just like you would for a medical injury. Let’s say something happened; they
would do triage and if somebody needed follow up, they would do it.
Or, it could be just having some presence. One of our teams, one of the things that they
did was they would actually go out to the watch posts, the outlook posts, that are all over
the outside perimeter; they would go out to them and just visit with people because you're
pretty lonely when you're looking out at a desert looking for the bad guys. They would go
out and just chat with them and just find out a little bit and see how they were doing. Just
being available and knowing that we were human beings and that we were actually fairly
good soldiers, that decreased the stigma a great deal.
One more thing that we did is, you see down on the bottom bullet there, it says the
Ramadi groups. Ramadi was a very dangerous city in western Iraq and a lot of Marines
were there. One of things one of our medics did was he received -- oh, it must have been
a 100 a 150 DVD’s from home. His friends just flooded him with DVD’s. He set up like
a little Hollywood Video in the clinic that he was located at, in the medical clinic he was
located at, and these marines would come in and they would come in saying they wanted
to use a DVD, borrow a DVD, but they knew what he did so then they would sit down
and say, “Hey, you know you’ve got to watch Billy over there because his girlfriend just
broke up with him.” It’s the old story of, “You’ve got to watch my friend” but really they
want to talk about themselves.
I found, what I would do because I was an officer, I was a field-grade officer, I would go
around to a lot of the higher officers and just let them know our presence was there, as
you said in your question. Then, eventually, they would start telling me a little bit about
what it’s like being away; what it’s like being in command. Because I was in a command
sport, I didn’t have the opportunity to do a lot of clinical work over there but one of my
things that I paid a lot of attention to was commanders over there. They needed a lot of
work because being in command -- you all have heard the expression, ‘it’s lonely at the
top’ -- well, when you’re in Iraq or Afghanistan, it’s very lonely at the top.
Hopefully that answers your question a little bit. We did a lot of it. These Ramadi groups
were very instrumental in cutting through stigma.
There is something else I want point out. Stoic Warrior groups which is based on stoic
philosophy and cognitive behavioral techniques, mostly cognitive techniques. This was
run, actually, by a former Special Forces guy -- I don’t think they're every former, but a
Special Forces guy who became a social worker. Our division was the 101st Airborne
and we would get these hardened 101st guys coming in there and talking about certain
stoic philosophy and things like that. Actually, we talked about what it’s like to be a
soldier and being in these types of situations.
Higher risk for combat trauma; this is pretty intuitive. Of course, friendly fire and seeing
the collateral damage, especially of children. You can just read through this stuff;
handling dead bodies, seeing someone else die. These are all high risk for combat trauma.
Preventative measures in the war zone; giving a lot of briefings. What I was talking about
before is doing debriefings in case an event occurred; we do a critical event debriefing.
Again, the research on critical event debriefing, though, is not very good but we would do
some kind of annotated kind of critical event debriefing. Also, other preventative
measures is be available through a chain of command, combat stress teams you can see is
a big preventative measure.
This is just some more major stressors while over there. Compassion fatigue, we found
was a big deal. That is the medics and not just our medics but medics in general, people
who worked in hospitals, surgeons, we would do a lot of work with surgeons over there,
trauma surgeons. Because, even though they're trauma surgeons, when they get over there
they were so busy that they were a little overwhelmed. A lot of our guys had a lot of
compassion fatigue.
Poor leadership; as you know from your own jobs sometimes, maybe, if you run across a
poor leader it can add to your stress level. Over there it really does push the stress levels.
As I said before, the communication and inability to participate in home front issues.
Risk factors - deployment and length and mental health; you can see as the deployment
went up, mental health factors became more of an issue. Deployment length and
separation; you see, as the deployment went on, more of a risk of planning divorce or
separation.
This goes back to an earlier question. Risk factors - deployment length and suicide; what
we found was the number of suicides you can see in the beginning of the deployment but
here, in the middle of the deployment, is when most of the suicides occurred. Again, this
is in theatre, most of the suicides occurred. The other thing to be pointed out here that I
point out to audiences is that right here is about, in month seven and eight, that is where
most people go home on leave. So they get a little taste of home then they come back.
This is a little bit of the same although this is suicidal ideation. You can see it has the
same kind of curve, mid-tour is when it’s at its height. It trails off.
Risk factors - separation and suicide; a little more about some of the factors. Failed
intimate relationship is the number one factor in percent of suicides. One of the things
that the Army has done is they do, basically, psychological autopsies on every suicide
that occurs, whether it be in theatre or at home. A lot of the statistics even the ones from
home are following the same statistics that you’re seeing there that failed relationships
are probably the number one contributor; failed intimate relationships, so partnership
relationships.
I suspect because, like I said, these numbers are from 2009 I suspect that the 2010
numbers, although I don’t have this exact chart for 2010, that these numbers are going to
be very different to the right of the screen. That job problems are going to really
contribute to some of the suicides. One of things you might know about this newest
generation, which we thought we weren’t going to have with this generation of veterans,
was job issues; joblessness and homelessness. But, that seems to be also on the increase
right now. I think veterans have a much higher unemployment rate than people who have
not served. The President, I guess, is signing a bill to try to do something about that.
Number of deployments and stress disorders; you can see this is just almost a repeat from
an earlier slide but you can just see how it goes up according to deployment. Again, look
at the third deployment, even though it increases, that could be any kind of deployment. It
doesn’t just have to be to a combat theatre.
“What is UCMJ?”
That is the Uniform Code of Military Justice. It’s basically their penal code. It’s their
laws. That’s what it is. I’m sorry I didn’t -- I’ll go back to that slide. That means people
who fell into UCMJ as a suicide risk. That was, they got in trouble in some way and
broke the law.
The laws are very different, by the way. It’s part of that military culture. The laws are
very different in the military. In other words, if you show up late for work in the military,
technically you broke the law because you abandoned your post. They get pretty strict
about that.
Any questions more about these numbers? Because I’m about to move on to something
else.
As I said earlier, the military really did see a problem, not just with suicide, but with
mental health and also risk. One of the things that we found was that when young men
and women came back that their behavior changed. They were a little more risky. They
were buying motorcycles. They were doing all kinds of high-risk behaviors. Their driving
was very wild. They were drinking and driving. The drinking would go up, not go up in
an overall rate, but their drinking would go up in a more reckless rate.
One of the things that happened in 2009 was the Army put out huge report -- which you
can get right online and that’s why I made a slide so you can just look at it and then pull
it down and download it yourself -- on health promotion, risk reduction, and suicide
prevention. The results of this really did start toward changing the culture of the military
because one of the things that the leaders in the military have been playing around with is
this idea that it’s not just the combat exposure, it’s not just the deployments although they
are major, major variables, that there’s something the military itself that needs to be
understood to understand military suicide.
The majority of service members, as I said earlier, that take their own life have not been
deployed. So, there’s something about the military culture that needs to get changed if
we’re going to bring down suicide in the military. Again, the goals are, like any kind of
suicide prevention, is one suicide is one suicide too many. The military carries that goal.
It can be proposed that to understand suicide in the military one needs to, as I’ve been
saying throughout the whole afternoon now, one really needs to understand military
culture and what that’s all about.
Actually, I just got -- you’re seeing more and more, and for those of you who are not in
the military, there’s more and more kind of seminars or talks being given about, basically
Military 101. What is the military culture? What is it? How is it different than the civilian
culture? Because, unfortunately or fortunately, I think more fortunately, a lot of these
men and women that come back, particularly in the Northeast where we don’t have large
military bases, civilians are going to be the ones treating this group of veterans. It’s not
just people at the VA.
Someone mentioned -- we were talking about women before and what we’re finding is
that women are kind of flinching away from the VA. The VA is doing a tremendous job
trying to attract women to get their treatment there but they are flinching from it. That is
where the civilian population and civilian providers can really pick up and help female
veterans. Understanding the military culture is very, very, very important.
On this slide, it’s just a kind of a graphic to show that when you have an increase in
depression and PTSD, you have an increase in the traumatic brain injury which isn’t in
the scope of this talk, when you have, of course, there’s an increase in traumatic
amputations because of the tremendous equipment that’s being given out these days and,
of course, we’re seeing a slight increase to an increase in drug and alcohol use. All of that
adds up to what? It adds up to a perfect storm that’s going to increase your suicide rate
because all of these variables together will increase your suicide rate.
Here’s another comparison of 160 active-duty suicides. You can see that 18 of them were
from the National Guard while they were on active duty. Five of them were from the
Army Reserves while they were on active duty. Then, this remaining percentage, it’s here
to the left of that pie chart, were people who were not on active duty or were not
deployed or in a full-time status when they committed suicide. You can see that the chart
down at the bottom also says the same thing.
This also is what I call the bulls-eye of the view of that storm, that perfect storm. One of
the things from that report that if you thumb through -- it’s a large report so you’re
probably not going to read the whole thing -- but if you look at the executive summary of
it, you’ll see that what the Army is trying to do is to really look at these risk behaviors.
They're trying to promote more people going into outpatient behavioral care. They're
really trying to monitor the prescription drug use, inpatient behavioral care, and then that
all of that comes back and contributes to suicides instead of just zooming in on the
suicide rate itself.
I’ve got a few questions here. I just want to read some of these.
“You have avoided talking about the fact that leadership continues to promote the stigma
in actions that say, ‘We don’t tolerate mental health weakness in our unit because it
affects unit productivity.’ Do you think we are making any difference in that problem?”
I think that’s part of the culture I was talking about that we are trying to change. This is
going to take -- as you know, when you change cultures -- the Army just celebrated,
what? It’s 226th anniversary and there’s a lot of traditions and cultures that need to
change if we’re going to do something about the suicide rate. I think I’m seeing a shift,
but you’re absolutely right. I’m seeing it more, it’s not just because I’m an officer but I’m
seeing it more with the change of the stigma with the commanders. I think they are on
board with this. I had the privilege about ten days ago to talk with General George Casey
and he is all over this stuff but he is so high up, or was so high up, that he’s not talking to
the first sergeants. I think you’re question is a good one. Those are the people that we
need to deal with.
Recently, I was part of doing a survey a year and a half ago where we actually were
asking soldiers about stigma; not so much as it pertains to suicide, but as it pertains to just
mental health in general. What we found was that the younger guys or the guys that are
the privates and the specialists that they don’t worry too much about the stigma and the
commanders or the officers didn’t worry too much about the stigma, but it was those
senior NCO’s, the first sergeants, the sergeant majors that really haven’t come around
with this. There’s a lot of work to do right there. Hopefully that answers that question.
Next question here, “Can you clarify the statement that the majority of military members
who die by suicide have not been deployed. Where does PTSD and other issues from the
following slide come into that?”
Again, I think that’s something we’re trying to understand is; what is it? We actually are
looking at the screening process and that maybe people came in with some psychiatric
illness that was not picked up. That might be why that’s occurring more. That’s
something else that we’re trying to do, trying to address.
“I work with an organization that focuses on problem gambling. Do you take any
information on how gambling affects those in the military and veterans?”
Gambling is not something that I know a lot about in the military. It occurs in the
military. I don’t see a lot but that’s also because of my rank and my position so no one
would gamble in front of me. It is something that, again, we know from the civilian side
that gambling contributes a great deal -- people who have gambling debt contribute a
great deal to suicide.
“Is there any information of sexual orientation impacting suicide in the military?”
Not yet but I would be alerted to that.
The next question, “What does having a suicidal issue or a mental health condition have
on a career path?”
Well, it used to have a large negative on your career path but what’s happening now is
people are -- if they're doing what they're supposed to be doing then we are encouraging
them. We are doing everything we can so it doesn’t hurt their career. The other thing with
this question is it hurts somebody’s career in the military the way it would hurt anyone
else’s career in any other type of highly-watched profession. I always use the
comparison, I work at a teaching hospital and I don’t know if my psychiatric history was
given to my superior how that would go over. So, it’s not that much different in any other
setting, I think, especially a strong academic setting.
I think, that in itself, that stigma in itself isn’t unique to the military. I think we’re trying
to address that as much as we can. One of the biggest problems that this question -- I
want to alert people to that’s occurring, is that a lot of guys are doing what they're
supposed to be doing meaning that when they come home, they are talking about it just
like this question says. They're saying, “Yes. I was suicidal.” or “Yes. I’m depressed.” or
“Yes. I can’t sit in a room full of people.” or “Yes. I’m taking medication for
depression.” In their annual physical, what happens is they get flagged for that.
When you get flagged, well that means you lose your right to carry your weapon. That
means you lose your deployment. You might not be able to get deployed because you
can’t get deployed without a weapon. So, what has to happen is you then have to come
see me or an Army psychologist who then has to lift that ban and I am the person who
then either says, “No. That’s accurate. You cannot have a weapon.” or “Yes. You can
have a weapon and I’ll lift it.” So, we’re running into a lot of problems with that, with
overzealous clinicians and, yet, these guys are trying to do what they're supposed to be
doing, which is really a problem in the military these days.
Next question, “Too may suicides have a history of first sergeants basically saying ‘Make
my day.’ When the surviving families try to get that information they are shut down and
when we need practice full accountability transparency -- Both for near suicides and
those we lost. We must listen to the survivors. Are there any ongoing studies or surveys
with this in mind?” Colonel, just retired, George Paren.
I don’t know of any studies like that but I agree with you, sir, that that would be a great
study; to follow up with this as much as we can and to really look at each suicide and
what happened and to use full transparency towards this.
“Would this gambling among soldiers be something that could be tracked?”
It actually could. We could actually put it in one of the surveys. It actually could be part
of the next MHAT survey. So, it definitely could be tracked.
“This may be too broad of a question and its own presentation but do you have any
suggestions as far as suicide prevention in the university setting where the soldiers are
coming back to civilian life? How should a suicide prevention program be tackled when
wanting to reach this group of individuals?”
Now are you saying on a college campus? One of the things I’m going to get to,
hopefully, here -- in fact I’m going to scratch ahead just so I can do that -- is some of the
Comprehensive Soldier Fitness things that we’re doing. One of the things that they're
doing in schools is their using a lot of resiliency programs. I think the resiliency programs
can help, not just with reintegration, but also help with people who are trying to
overcome PTSD and things of that nature.
“You may not cover this today, but we must address family member suicides as well.”
Great point. Great point. “When they die outside our hospitals they are just forgotten.”
Great point, sir.
“You may want to go through the slides --” Okay got it. I’m going to go through the next
couple of slides here, most of them. I’m going to really skip through the charts.
This is one of the important ones that I like to put up there; relationship of drugs and
alcohol in suicide. You can see that, as you go through these numbers here, in 2008, 39%
of the suicides involved drugs and alcohol. You see that number went down in 2009. You
can see that the involvement of drugs and alcohol is pretty high throughout these
numbers, except 2009.
This slide just kind of outlines the methods and it’s just kind of intuitive also, the
methods, the location. You can see the breakdown on the top section up there. Suicides;
22% were in theatre, 73% were in the United States. Gunshot, again, because they have
the means most of the time. As we went over before, the major stressors for suicide were
relationships, although military work wasn’t far behind. Drug and alcohol involvement
not high, not significantly high, but high enough. Here is this thing now that opens my
eyes all the time; primary motivation, 41%, we don’t know what the primary motivation
was.
Some more demographics; you can see predominately male. That goes back to the
question earlier. Suicides are predominately male. There’s race; Caucasian,
predominantly Caucasian. About half and half military status; junior enlisted, those are
the younger guys. Career fields; so the infantry guys had a pretty low rate of suicide.
Again, that goes to combat exposure so it goes against the thinking that combat exposure
directly influences this. Deployment history; one or more.
I do want to spend a few minutes talking about reintegration and suicide. We’ve talked a
lot this afternoon about what happens in theatre but I want to spend a few minutes on
what happens when someone comes home.
I always say it’s the happiest day of somebody’s life but, soon after that, there could be
feelings of detachment, not belonging to the world, and the world went on without them.
A big variability between the Reserve component and AC component, AC active duty
component.
The biggest difference is I can tell you that for the Reserve component people are -- they
can be sitting in Baghdad or Kabul or Kandahar and, one week later, be sitting in their
living room without a uniform on and just gone from one highly-intense, high-tempo
operation, combat operation, back to their home in Lexington or wherever they're going
to, Southie, within one week.
The AC component, or the active duty component, comes back to a base. They come
back to other people who are all in uniform. They come back to their kids who were with
other kids who had fathers and mothers who were deployed. There’s a big difference
between that, those two components.
The other thing is that what the soldier tries to is they try to use the same skills that they
used in theatre, at home. If they were using defensive driving, if they were hyper-vigilant
to the roads, they’ll use that as defensive driving when they came home.
Reintegration varies from soldier to soldier. There’s no set process. Simple tasks; one of
the common things are simple tasks seem difficult or boring. Driving is not comfortable.
It’s often reckless. A lot of people, one of the major things I hear with soldiers when they
come back is irritability over small issues and also the biggest thing, which takes years
from what I’m hearing to go away sometimes, is not being comfortable around people.
Roles have shifted. Another big part of reintegration is soldiers lose developmental stages
of their child’s life. For example, if you’re a soldier, if you’re a mother and you’re a
soldier and your child is three years old, you come back and your child is now four and a
half years old you’ve lost a whole bunch of time with that child at that point.
This is just a slide that outlines the battle-mind thinking where you’re using combat skills
and you're transferring them in a healthy way to a home, to the reintegration skills.
Comprehensive Soldier Fitness; this is one of the major, major interventions that the
Army has made over the past couple of years. As I said, General George Casey, the Chief
of Staff, has made it his personal project. There’s just a quote from General Casey. One
of the big things he preaches is that, his thinking is that we should mental health the way
we present physical fitness. That is if somebody’s struggling on a PT test and they need
intervention so we’ll give them extra help, give them a remedial, get help for their
physical fitness; well then, we can do the same thing with mental health and that’s the
way we should approach it. It’s more of a holistic approach that also includes substance
abuse. Training the person emotionally the same way we treat physical training, that’s as
I said before.
A big part of Comprehensive Soldier Fitness is this thing called the resiliency training,
which is based Marty Seligman’s positive psychology. It teaches leaders to instill
resilience in their subordinates. There’s a whole campaign going on -- this goes back to
one of the earlier questions -- that we’re really trying to send this out to the NCO’s, to
those middle-level leaders, and teaching them about resilience and how there’s different
ways of leadership and how to build mental health within your training year.
Some of the early results, what we’ve found, this is the articles at the bottom of that slide;
that there’s fewer symptoms of PTSD, less symptoms of depression and stress, and the
best, the most positive, results came from those, the high levels of combat.
Every soldier will transition home in their own way. Build on a soldier’s given strength.
This is all part of resilience.
I’m going to summarize some things here. This is a new generation of veterans, different
characteristics which means we need to adjust our treatment methods accordingly. We
will see the results of combat stress reactions in many years to come, particularly around
psychological adjustment and addiction. Continued collaboration between military and
civilian groups so all clinicians can understand the uniqueness. This is understanding the
military culture which I think is a big part of this. Again, seek out the training in
supervision and military cultural issues with regard to suicide and the impact that that
culture has.
The main thing that I can tell people and I tell people, because I get approached all the
time by colleagues who want to treat veterans and people in the military and they want to
think they need special training. Other than learning about the culture, the main thing I
tell people is to listen to their story. Every veteran has a story and if someone can listen to
their story and be curious about their story and not pathologize their story I think that
you’ll be able to help a lot of people coming back.
I can tell you -- I’m running out of time here -- but I can tell you there’s many, many
successes out there. Unfortunately we live in a media society where we report the
negatives a lot but there are a lot a lot of successful stories out there with mental health in
the military and hopefully I just gave you a snapshot of what’s going on with that.
I want to check to make sure that I’ve gotten all these questions.
“Coming home in unemployment.”
Unemployment is a big deal. As I said earlier, it’s rising and we’re going to see more and
more of that as a problem. As I said earlier, the unemployment rate amongst veterans is
much higher these days than it is for the civilian population. Again, I believe the
President has put forth or signed some legislation to try and do something about that.
“I believe we need to address spiritual fitness.”
I agree, as well.
“This is where we fail to make a difference throughout the U.S. Do you see us integrating
more mind, body, spirit programs as a way to break this trend?”
Yes, I do, actually. I think the resiliency program is part of that. If you look at the slide
on Comprehensive Soldier Fitness, spirituality is a part of one of the points on this star.
The other thing that we’re doing is we’re really working hard with the chaplains where
we used to be in two different camps. The chaplains would do their thing and mental
health providers would do their thing. We’re working very, very closely together with the
chaplains and we are trying to bring more of a spiritual component.
As I said, if anyone wants the slides, I’m not wed to them. You can access the slides and I
will also send the updated MHAT results with that. This concludes my talk.
Brandy Brooks: Dr. Rodolico, just before we end I’d like to thank you and also reiterate
to everyone, as I said earlier and as Dr. Rodolico reiterated, the slides will be emailed to
you as well everyone will see a link for this podcast so you can watch it as well as
distribute it to your networks, all this wonderful information that has been shared today.
As well, be on the lookout for emails about upcoming webinars and trainings sponsored
by the Department of Public Health. After you log off today, please take a few moments
to complete the evaluation. I hope that you’ve gained more knowledge about the recent,
trends, policies, and techniques used to help veterans and military personnel exhibiting
suicidal ideation and/or behaviors.
Thank you, Dr. Rodolico. Thank you all for participating and have a wonderful day. I
don’t know, Dr. Rodolico, if you have any concluding comments you want to add.
John Rodolico: I think I already made it which is that we’re moving forward with this.
This is a tough slug and I think we’re going to keep doing this for many, many years to
come as these conflicts hopefully keep winding down and we bring our boys and our girls
home. We’ll just keep fighting all of this stuff. I want to thank everyone for listening and
putting up with a little clumsy on the technology but hopefully this was helpful.
Brandy Brooks: Thank you all. Have a good day.