Improved behavioral health needed to respond to rising number of suicides among US Armed Forces

Needed changes include making service members aware of the advantages of using behavioral health care, ensuring that providers and chaplains are delivering high quality care, and assuring that service members can receive confidential help for their problems, according to the report.

"Efforts should focus on changing the culture at all levels of the military to encourage those in distress to seek help along with efforts to identify and intervene with service members who are at risk of suicide," said Rajeev Ramchand, the study's lead author and a social scientist at RAND, a nonprofit research organization. "While the military already has made many important changes, there is still more that can be done."

RAND was asked by the Department of Defense to evaluate information about military suicides, identify the agreed upon elements that should be a part of a "state-of-the-art" suicide prevention strategy, and recommend ways to make sure the programs and policies provided by each military service reflect the best practices.

Suicide rates in the military have increased sharply since 2001, rising from about 10 per 100,000 service members to nearly 16 per 10,000 service members in 2008. Historically, the suicide rate in the military has been lower than the adjusted civilian suicide rate, but the RAND study shows that in recent years this gap has narrowed. The increase in the military suicide rate has been driven primarily by an increase in suicides by members of the Army.

RAND researchers reviewed research relating to a wide range of suicide prevention strategies and concluded that while some practices show promise, there is sparse evidence showing that programs or interventions reduce suicide. The bulk of the evidence that does exist focuses on the delivery of high-quality care for those with behavioral health problems and those who are at imminent risk for suicide.

Researchers prepared a series of recommendations aimed at strengthening suicide prevention program across the military services, including:

• Track suicides and suicide attempts systematically and consistently across all of the military services. While the Department of Defense has adopted a new surveillance program, it is important to make sure each of the military services uses the same criteria to define suicide attempts and that information is shared among different military services.
• Raise awareness and promote self-care by encouraging those in need to seek help and ensure that suicide-prevention efforts are linked to other behavioral health programs across the armed services.
• Improve efforts to identify those at risk for suicide through strategies such as educating gatekeepers about how to identify those having troubles and improve surveillance programs to help identify risk factors.
• Facilitate access to quality care by making service members aware of the benefits of behavioral health services and by educating them about the different types of behavior health care providers that are available to them.
• Develop procedures to restrict access to lethal means for those at high risk, such as standardized "unit watch" or "suicide watch" policies.
• Provide military leaders with guidelines on how to respond to suicides that occur under their command to help other service members deal with the loss.

The study, "The War Within: Preventing Suicide in the U.S. Military," is available at http://www.rand.org/pubs/monographs/MG953.html. Other authors of the study are Joie Acosta, Rachel M. Burns, Lisa H. Jaycox and Christopher G. Pernin.

The research was by the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies and the defense Intelligence Community.