One idea is to expand confidential counseling programs that give distressed soldiers a safe space to talk about their problems without the perceived shame they often experience when seeking help. For example, programs like Military OneSource and Military Family Life Consultants appear to be popular with service members and their families. In addition, the Army’s Confidential Alcohol Treatment and Education Program is another resource that earned positive reviews. However, after three years the program has not expanded beyond six posts. The military also tested counseling over internet based video conferencing known as the TRICARE Assistance Program. This program also appears to have been well-received, but unfortunately was cancelled last year. Perhaps the program needed to be better marketed to expand its use, and should have been given more time to determine its effectiveness.
Another step that should be considered has to do with coordination of care. The value of clinical coordination was demonstrated by Lieutenant Colonel Christopher Warner and others in their American Journal of Psychiatry article in April 2011. They reported a reduction in “occupationally impairing mental health problems, medical evacuation from Iraq for mental health reasons, and suicide ideation” in the soldiers who deployed to Iraq from 2007 to 2008. This model should be implemented throughout the military. Mental health care must be coordinated across all services: for post-traumatic stress, traumatic brain injury and substance abuse, and mental health care should be embedded in primary care. While steps have been taken to improve care coordination using the medical home model and embedded behavioral health, these efforts have not yet addressed all specialties. The system should be fully integrated to achieve the benefits of care coordination.
And finally these initiatives should be implemented at the local level. Installation commanders should have the ability to adapt programs to meet the needs of their community. Suicide prevention programs need to be research-based, but also adaptable to fit local needs. Allowing more flexibility as programs are used at the commander level may help build trust and enhance buy-in. Larger bureaucracy will not solve the problem, agility and initiative are needed.
It will take time to change attitudes about mental health among members of the armed serves, and to break down the barriers that deter soldiers from seeking help. Until then it is imperative that the military take steps that have been shown to work - confidential counseling programs, coordinating care and flexible programs that can be used by base commanders. This will help ensure that soldiers experiencing problems that put them at risk for suicide receive the treatment they need and deserve. As with suicide prevention in the general public, prevention is complex and sometimes can seem futile, but prevention is possible. We must do more to stem this tragic loss of life.
Gebbia is executive director of the American Foundation for Suicide Prevention.