"We lost a soldier yesterday," Maj. Gen. David Rubenstein, the
Army's deputy surgeon general, told Sens. Ben Nelson (D-Neb.) and Lindsey
Graham (R-S.C.) at a Capitol Hill hearing in March.
The general wasn't talking about the latest battlefield casualty from Iraq
Hearings in Washington too often sound like Kabuki dramas, scripted and
ritualized, hinting that the real work goes on behind the scenes. Witnesses
read from preprinted statements; legislators ask questions prepared in advance
by their staffs.
But on this day Rubenstein ignored the script and went to the heart of the
matter in testimony before the Senate Armed Services Subcommittee on
Personnel—suicide prevention in the military services.
"This man received a traumatic brain injury in a motorcycle accident
and had been in treatment for two years," he said. "He gave talks
on the benefits of treatment. He saw his psychiatrist on Friday. He saw his
primary care doctor on Monday morning and his nurse case manager on Monday
afternoon. He was treated, he was compliant, but he killed himself."
Rubenstein was just one of seven generals and one admiral, including the
second-highest-ranking officers in the four branches of the U.S. armed
services, who testified to senators about the status of their
Suicide has not left high-ranking officers untouched either.
"Every naval officer of my generation remembers where he was when he
heard about Mike Boorda's suicide," recounted Adm. Patrick Walsh, vice
chief of naval operations. Adm. Michael Boorda killed himself in 1996 when
news reports said he was wearing a medal he was not entitled to wear.
"The reality is, we're dealing with a tired and stressed
force," said Army Vice Chief of Staff Gen. Peter Chiarelli.
Two-thirds of the 140 Army soldiers who committed suicide in 2008 (a rate
of 20.2 per 100,000) were currently or formerly deployed to the two
Middle-East war zones, which contributed to their stress and anxiety, he said.
The present era of "persistent engagement" with its 15-month
deployments and the stress they cause was not likely to end soon, so the Army
had to do what it could to mitigate that stress.
Suicide rates in other services have gone up too, but not as much as those
in the Army. The rate for 2008 was 20.2 per 100,000.
Gen. James Amos, assistant Marine Corps commandant, told the Senate panel
that the Marine Corps saw the number of suicides rise in recent years from 25
in 2006 to 41 in 2008 (the latter statistic indicating a rate of 19 per
"These increases are unacceptable," said Amos. "The
tragic loss of a Marine to suicide is deeply felt by all those who are left
The Air Force instituted its own suicide-prevention program in 1996 and saw
rates fall, although rates rose again slightly in 2008 (to 11.5 per 100,000)
over the previous 10-year average, said Gen. William Fraser III, Air Force
vice chief of staff.
All of the armed services have instituted suicide-prevention programs. The
Army, for example, instituted the "Ask, Care, Escort" program to
overcome the stigma surrounding seeking mental health care among soldiers. It
required unit commanders to conduct two to four hours of training for all
soldiers and civilian employees between February 15 and March 15. The Air
Force has its "Wingman" program, in which airmen are trained to
watch out for each other. The Navy and Marines have their "Operational
Stress Control" program to try to prevent suicides.
However, none of the service vice chiefs who testified was satisfied with
the status and success of his branch's existing prevention efforts.
Asked what else could be done, they all said that additional mental health
clinicians of every variety would be a first step, although they have all
recruited several hundred new personnel in the last few years. Persuading
social workers, psychologists, and psychiatrists to enlist in the uniformed
services is the most preferable strategy, because they can be sent wherever
the troops go, but some of the newly hired mental health clinicians have come
on board as civilian employees or as contractors, whom the Pentagon does not
send to war zones.
Improved continuity would help too. Physicians or other health
professionals currently leave their posts at military hospitals when they are
assigned to a unit in the field, but then return to their home bases
afterward, leaving the troops to start over with another set of health care
providers, said Chiarelli.
The Marines have begun embedding mental health professionals in combat
units while they train in the United States before deployment, said Amos. The
same clinicians stay with the unit during service in Iraq or Afghanistan and
return home with it following deployment. That process was designed to build
familiarity and trust between the clinicians and the Marines and thus lessen
their reticence to seek help.
Overcoming soldiers' reluctance to seek help, however, requires more than a
roster of programs, said Chiarelli. "We need to change the culture of
Or as Rubenstein put it, "Stigma is not a problem between the soldier
and the health care provider but between the solider and the
Walsh agreed: "The challenge is to get people to the point where they
don't fear they'll be hurt or stigmatized by asking for help."
Stigma is a "toxic, unacceptable workplace hazard," said Brig.
Gen. Loree Sutton, an APA member and director of the Department of Defense's
Defense Centers of Excellence for Psychological Health and Traumatic Brain
Injury. "[The department is] committed to transforming its culture by
emphasizing that seeking treatment is an act of courage and
In concluding his testimony, Chiarelli said he will be briefed on every
suicide in the Army this year. The first round, covering 15 events, was"
one of the most intense two hours of my life," he told the
Prepared statements and an archived Webcast of the hearing are