Providing sensitive mental health treatment to patients who have served in the military requires better understanding of this unique culture. Toward that end, this news organization recently sat down with Col. (Ret.) Elspeth Cameron Ritchie, former chief of psychiatry for the U.S. Army and the current chief clinical officer in the department of behavioral health for the District of Columbia. The following is an edited transcript of a discussion with Dr. Ritchie*.
Question: Why are there more suicides among service members who’ve never deployed than in those who have been in-country?
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One of the realities is that if you're motivated to come into the service, you're probably not going to talk about your mental health problems.
Dr. Ritchie: For many years, there was a relatively stable suicide rate at about 10 per 100,000 troops per year. Starting in 2004, the rate more than doubled, so that by 2010, 2011, and 2013, we had very high suicide rates for the military. The suicide pattern also shifted over time. In the beginning, there was a lot of concern that the rates were related to deployment; although in individual cases, the deployment may have caused some stresses, by and large the suicides did not seem to be directly related to individual deployment, and now more than half the suicides occur in those who’ve never deployed.
Why is that? Well, it’s complex, but one of the reasons I look at is that the army itself has been on a high operations tempo, so troops are deploying all the time; they’re tired, so one of the things that’s going on is that when a new soldier joins a unit, they might not be welcomed in the same way as they would have been in the past, because everyone’s so busy. So, that’s one piece of it.
But, let me go big picture. For a long time, the stressors that led to suicide have been all about failed relationships and also getting into trouble at work or having financial troubles. And that pattern has stayed the same over time, but the number of troops who have suicided has risen over time.
Question: So it’s the social structure of the military driving this, at least in part?
Dr. Ritchie: That’s one of the drivers. The people are just so busy, by that I mean the units, who have so busy going back and forth. So, for example, if you look at the 101st Division at Fort Campbell, they have been in and out of the theater of war almost every other year for a long time, they’re slowing down now a little, and they had a very high suicide rate for a number of years. And that’s not dissimilar to the other bases like Fort Stewart and Fort Hood; they are all deploying troops very rapidly in and out of the theater of war.
Question: Does the military need to sensitize its troops to welcoming in recruits?
Dr. Ritchie: The military has been very concerned about the suicide rate, and they have done a lot about it, with perhaps the beginning of some success in that the suicide rate among active duty troops is starting to level off, but the rate is rising in the Reserves and National Guard. But, for example, there was a Department of the Army task force to look at this, and it started out as suicide prevention, but then they added risk reduction, and they then added health promotion as part of it. Then there was the Department of Defense task force with many, many recommendations. And basically, the easy recommendations are all done. Recommendations that are harder to do, like ending the conflicts of wars, well, the wars are finally winding down, but that’s not something you can just "stop," and as the military, it’s your job to go to war.
Dr. Elspeth Cameron Ritchie
Question: Is the military screening recruits well enough? Maybe they are coming in with too many problems to begin with.
Dr. Ritchie: There already is quite a bit of screening. There are some misconceptions about that. As a matter of fact, there is a bill going to Congress about that now, that calls for adding mental health screening. There already is a history and physical done as a young recruit tries to enter the military, and they’re asked about mental health problems. But one of the realities is that if you’re motivated to come into the service, you’re probably not going to talk about your mental health problems, because you’re worried that will disqualify you from service. Already, only about a third of people who apply to the military are able to make the mental health and physical standards. So, there is a screening.