Hope, Help, Heal: Suicide Prevention and the Military

Most military families will tell you that the trajectory of their lives was drastically altered following the attacks that took place 16 years ago, on Sept. 11, 2001. It was no different for my young family. We were stationed in Enid, Okla., and my husband was a Marine Corps instructor pilot, training student pilots to fly T-37 trainer jets. We had two young boys, ages 4 and 6. Oklahoma was supposed to be our last duty station before we transitioned back to civilian life; we planned to leave the Marine Corps and move home to live near our families in Massachusetts. My husband, Maj. John Ruocco, just happened to be home that morning and we were enjoying a cup of coffee together when we noticed “breaking news” on the television. We sat in stunned silence as we watched the second plane hit the second tower. My husband took a deep breath and said, “this is going to change everything for us.” Four years later, three months after he returned from a combat tour in Iraq, my husband died by suicide.

As a military spouse, I was used to the military lifestyle. I was used to pushing through, sucking it up and overcoming obstacles as well. There was an unwritten rule that you did not tell anyone if your husband or family was having problems. For a Marine pilot, reputation was everything. When my husband began to suffer, I could see it, but I did not know what to do about it. I feared that anything I did could make things worse for him and that he would feel like I betrayed him if I told his command that he was not ok. I also feared he would lose his job and our way of life. I did not understand that untreated mental illness can be deadly. I did not know that there was treatment for his suffering. I did not know then many of his peers, and trusted leaders had gotten help, gotten better and were back in the cockpit.

The night my husband died I begged him to get help. He agreed to do so, but he said to me, “we are going to lose everything, they are going to think I just don’t want to deploy again.” He also wondered why he was suffering while other Marines who had similar experiences did not seem to have a problem. I tried to comfort and encourage him, but I was worried. I asked him directly if he was thinking about killing himself. He responded with “I could never do that to you and the boys.” My husband killed himself a few hours after that call; he never went for help.

The Problem of Numbers
The National Institute for Mental Health reports that in 2013, 18.5 percent of American adults over 18 had been diagnosed with a mental illness within the past year.  That’s 43.8 million Americans and does not include drug- or alcohol-related disorders. According to the Army STARRS Study, 25.1 percent of soldiers surveyed met the criteria for a mental disorder in the past 30 days.  In the study of new soldiers joining the Army, 38.7 % reported having had one or more of the DSM IV disorders in their lifetime. I share these numbers with you because I want you to realize and truly understand that mental health issues are a common part of the human experience. They are not something to hide or be ashamed of; they are something to be treated. Given these statistics, there should be an expectation that a proportion of the population will need mental health care at some point in their lives. This should be especially true for our troops who are exposed to combat, dangerous training and frequent losses.  The same way that a paratrooper may need ankle surgery or an infantryman a knee replacement, or a Marine exposed to burn pits may get cancer and need chemotherapy, a service member may, at some point in his or her life, need mental health treatment.

Suicide in the military has been a concern for the Department of Defense ever since rates began to increase following the U.S. invasion of Iraq in 2004. The rates continued to increase steadily, peaking in 2012, and remaining relatively stable over the past few years. In 2014, the military suicide rate was 19.9 per 100,000 service members across all services.

It is difficult to compare these numbers to the civilian suicide rate unless you compare for age, gender and other factors; however, to give you an idea, the civilian rate of suicide for 2014 was 13 per 100,000 with 43,000 Americans dying by suicide that year. Many experts have studied these numbers and tried to understand what they mean and what can they do to prevent future suicides.

In recent years, it became en vogue to use the number 22 to raise awareness about veteran suicide. Push-up challenges and other campaigns highlight this number, but many of them do not include a hopeful message or appropriate resources.  This campaign has raised a lot of awareness and has given action items to people who want to make a difference, but focusing on losses alone can increase hopelessness for those who are suffering. A good example of this is illustrated in a suicide note left by a veteran who recently died. In his note, he stated, “I will be one of the 22 that die today, there is no hope.” This note and similar feedback from veterans inform us that we must think about those who are suffering when we roll out campaigns. Hope must balance loss and resources must be included.

First and Foremost, Words Matter

The words we use matter: the way we talk about suicide and the words we use can influence risk. A good example of this is the terms “successful suicide” or “failed attempt;” those at risk may hear success and failure and be influenced by it. “Committed suicide” is another term that should be avoided. For suicide loss survivors, this term implies that the person at risk was making a clear, conscious decision when we know that those who die by suicide are in a very narrowed state of mind. The word “committed” is also associated with bad acts such as committing a crime or adultery. A person that dies by suicide is most likely very sick, not bad. Here are some terms that are encouraged by experts: “died by suicide,” “completed suicide,” “suicided.” Using these terms will help decrease stigma and show survivors of suicide loss and attempts that you are sensitive to their journey.

Another area of concern is messaging about suicide in the media. When a high-profile death by suicide is reported by the press, I often cringe as reporters give detailed accounts of the method used or other in-depth information. Doing so actually increases the risk of copycat acts, because it glorifies the death and creates an image of the act that can be alluring to those at risk. Graphic descriptions can also be triggering to those who suffer trauma related to their loved one’s death. To learn more about safe messaging around suicide, in-depth guidelines for reporters are available, many of which I discussed in a webinar last year.

What We Can Do: #BeThere

People who are in distress listen and watch very closely to those around them. They try to figure out if it is safe to ask for help. Will I be ridiculed? Will it negatively affect my career? Will it change the way people view me?

Overwhelmingly, people want to help prevent suicide, but most do not know what to do. If you are concerned about someone you love, there is hope -- treatment can work.

Changing the Culture

It is time for us to think about mental health in the same way we think about physical health. We make time in the day for PT, and we must start doing the same for mental health and wellness. If a service member needs to go to treatment, whether for a suicide attempt or mental health issues, they need to have the time and support to integrate that into their day. If a service member feels like he or she is burdening others to go to treatment, then this will add risk to a person who is already struggling. Creating regular time frames for mental health, be it mindfulness, meditation or clinical treatment, decreases stigma and ensures that everyone is making mental health and wellness a priority. Additionally, when a person is in treatment it is imperative they maintain a feeling of connectedness and value within the unit.

Suicide is one of the many ways that a service member can die. It often happens after many years of dedicated, difficult service. Many who die by suicide have given until they had nothing left to give. In the military, there is a lot of focus on HOW one dies. Deaths that are considered heroic are honored and revered, medals are awarded, and monuments are built. For survivors of military suicide, there is a fear that their loved one will be remembered for how they died, instead of how they lived and served. Let us all remember that those who serve are part of the less than one percent that volunteered to put their life on the line for the freedom and safety of others; let’s honor and remember the incredible life lived.

Kim Ruocco, MSW, is Vice President, Suicide Prevention and Postvention at the Tragedy Assistance Program for Survivors (TAPS). Since 1994, TAPS has provided compassionate care for the families of America’s fallen military heroes and has offered support to more than 70,000 surviving family members and their caregivers, including special programming for those affected by a death by suicide. If you have lost a military loved one to suicide, you are not alone. For more information, visit taps.org or access TAPS 24/7 Helpline at 800-959-8277.