Army announces rise in suicide rates for 2008

In a November 2008 interview with the Jim Lehrer NewsHour, the Army’s lead psychiatrist, Colonel Elspeth Ritchie, M.D., said, “In soldiers who had deployed once, about 12 percent had symptoms of anxiety, depression, and PTSD [post-traumatic stress disorder]. If you had deployed three times, that number rose from 12 percent to 27 percent. So, there clearly is an impact of repeat deployments on the mental health of soldiers.”

At a Pentagon press conference yesterday, Army Vice Chief of Staff General Peter W. Chiarelli said that of the 2008 suicides, the majority – 65 percent – were committed by deployed or recently deployed service members.

In recent years, the deployment to dwell time ratio (“dwell time” refers to time spent un-deployed) has been less than ideal. The Marine Corps aims for a ratio of 1:2, with Marines receiving roughly twice as much time out of rotation as in. But the Army is still aiming for a 1:1 ratio. Despite meeting recruitment goals, it has been hard-pressed to find enough troops for Afghanistan and Iraq, and soldiers have received, on average, far less down time than needed, adding to the stress of deployments. In April 2008, the Army announced that it would reduce deployment lengths to 12 months, in the hopes of achieving a 1:1 deployment-dwell time ratio, but a 1:2 ratio, which is considered more adequate, is not envisioned until 2011.

To address the rise in suicide rates, the Army has launched an initiative with the National Institute of Mental Health and the Department of Veterans Affairs (VA) to identify better suicide prevention measures.

But the Department of Veterans Affairs has come under intense scrutiny for its inability to process claims quickly and fairly. Veterans struggling with the conditions that often lead to suicide – PTSD, depression, anxiety – often complain that their medical treatment is delayed and inadequate. And there are documented instances in which clearly justifiable disability claims, which help pay for the medical treatment veterans need, are denied.

The NewsHour reported one instance in which an Iraq war veteran was told he didn’t qualify for benefits because he hadn’t proved that his PTSD was service-related. Despite describing the graphic scenes he’d witnessed, Scott Eiswert, an Army National Guard specialist, was unable to remember the dates of the incidents he’d witnessed or the names of those he saw killed. The VA repeatedly denied Eiswert’s disability claims and only awarded them after he committed suicide in May 2008.

Part of the problem is that the VA is understaffed at a time when its workload is increasing dramatically. As of September 2008, the VA had 278,565 employees – the second largest number of any government agency or department. (Only the Department of Defense is larger.) Even so, the department seems to find it difficult to keep up with the rapidly rising demand for services. In February 2008, the VA reported in a press release that it would treat “about 333,000 OIF/OEF [Operation Iraqi Freedom/Operation Enduring Freedom] veterans in 2009, a 14 percent increase over the estimated 2008 figure. Medical care funding for these patients will climb to nearly $1.3 billion in 2009, or 21 percent more than in 2008.”

The VA also reported this month that it would make disability compensation payments “to 234,000 more service-disabled veterans and their survivors in 2009” than in 2007. And it expects its actual operating budget for this year to be 7 percent greater than its appropriated budget – $93.4 billion, compared to $86.7 billion, with the vast majority – $86.9 billion – spent on health care and benefits.

Compounding the problem of an inefficient VA is cultural resistance to attitudinal change within the Army. The Army has taken commendable steps to increase awareness of the symptoms of PTSD and TBI (traumatic brain injury – another common battlefield injury in Iraq and Afghanistan, with physical and psychological effects) and has tried to combat the stigma that acknowledging psychological injury is a sign of weakness.

But many soldiers with symptoms of psychological injury still seem to be expected to tough it up and, to use a sports term, “play through pain.” Soldiers who have been diagnosed by the Army with PTSD or TBI are sometimes sent back into the field. Despite showing obvious signs of instability, other soldiers, unable to feel comfortable in civilian society, convince the Army that they should be sent back – only to be returned to the States soon after and institutionalized for psychiatric treatment. And once here, returning soldiers with psychological injuries are sometimes treated with astounding insensitivity: In June 2008, for instance, the Washington Post reported that troops who were being treated for PTSD at Fort Benning were housed next to a firing range that was used routinely.

The Army proclaims itself proud of its “Wounded Warriors.” And I believe it – kind of. We’re all proud of our Wounded Warriors. But given this latest report on suicide trends and the Army’s and VA’s worrisome histories of providing less-than-adequate services to those who’ve served, it’s worth wondering whether our Wounded Warriors are really receiving the best care possible. For an organization that demands more than the best, and for those who deserve better than the best, that’s the least we can expect.