Thursday, January 15, 2009

U.S. Marine Suicides Highest Since 2003, Incoming VA Chief Promises Reform as Gulf Vets Testify on VA, DoD/VA Suicide Conference

The past two days have been stunning.

Seven years into the uptempo stress of our extended wars in the Middle East, as a first-ever joint three-day DoD/VA suicide prevention conference wound down in San Antonio, news came that the selected topic of study remains desperately relevant and urgent. Tony Perry, Los Angeles Times:

More active-duty Marines committed suicide last year than any year since the U.S.-led invasion of Iraq in March 2003, although the suicide rate remained virtually unchanged because the Marine Corps is increasing in size, according to a report issued Tuesday.

Forty-one Marines are listed as possible or confirmed suicides in 2008, or 16.8 per 100,000 troops, the Marine Corps report said. Nearly all were enlisted and under 24, and about two-thirds had deployed overseas.

In 2007, 33 Marines committed suicide -- a rate of 16.5 per 100,000 troops. The Marine Corps is adding troops and calling in reservists to serve in Iraq and Afghanistan, as well as other foreign bases and stateside.

The Marine suicide rate is still below that for civilian populations with similar demographics -- 19.5 per 100,000. It is also less than that of the Army in 2007 (18.1 per 100,000). The Army suicide figures for 2008 have not yet been released, but officials said late last year they expected the number and rate to increase from 2007. [More OEF/OIF suicide stats].

The suicide rates for the Marines and the Army have been closely tracked because the two services have borne the brunt of the fighting and repeat deployments in the Middle East.

What's really disturbing about this news is that any increase has taken place, countering an aggressive Marine Corps suicide prevention campaign. Considering their laudable efforts, the figure takes on a starker tone.

Today, as General Eric Shinseki sat down before Congress in Washington, D.C., for his confirmation hearing to speak of his desire to improve VA services for our veterans, a nation's breadth away, Gulf War veterans appeared before a special VA panel assembled in Seattle, Wash., to tell of the care they have received over the years.

In educational interest, article(s) quoted from extensively.

Thom Shanker, New York Times:

As President-elect Barack Obama’s nominee to head the second-largest bureaucracy in the government, behind the Pentagon, General Shinseki said that if confirmed he would streamline the disability claims system, use new information technologies to improve the delivery of benefits and services, and focus on unemployed and homeless veterans.

He also said the nation would more effectively fulfill its promise to take care of wounded veterans, those “bearing scars of battle, some visible and many others invisible,” a reference not only to those with physical wounds but also to those suffering from post-traumatic stress and traumatic brain injuries. ...

General Shinseki said he was troubled by the department’s history of lost or misplaced medical records. And he said the department must work to ensure that those leaving military service make a seamless transition to veterans’ health care. If confirmed, General Shinseki said, the department “would treat our veterans with dignity and respect.”

“For the V.A.,” he said, “the single focus for transformational change should be the veteran — providing for generations of veterans, who have done their duty, the support and services they have earned and we have promised.”

Mark Barber's piece in the Seattle Post-Intelligencer showcases some of the very real challenges facing the VA:

A special Veterans Affairs panel aiming to do justice for the long-neglected veterans of the 1991 Persian Gulf War convened in Seattle on Wednesday -- at the same time retired Gen. Eric Shinseki was testifying at a Senate confirmation hearing Wednesday to be the new VA secretary.

While Sen. Patty Murray, D-Wash., spoke at Shinseki's hearing about the need to change the current culture of the VA, several veterans in Seattle told the 14-member Advisory Committee about problems they had after returning from Operation Desert Storm 18 years ago.

Each veteran had fallen ill in the 1990s and never recovered from similar, mysterious symptoms they said they were discouraged from reporting or treating after returning from war:

"I felt kicked out, humiliated ... I looked elsewhere for answers" and dropped all contact with the VA in 1996, said Mark Nieves, 38, of Seattle. He came home ill displaying a variety of mysterious symptoms after serving as a cavalry scout with the 1st Armored Division in the 1991 Iraq invasion.

Lee Christopherson, 47, of Seattle, a former Coast Guard commander who also served in the Iraq war in 2003, was urged to attend the meeting by his mom, who said she wanted him to share what she had seen him bottle up over the years, including multiple strokes, blood clotting, vascular dementia, severe joint pain, fatigue, sweats, and involuntary muscle spasms all over his body.

"I had significant medical issues but I avoided recording them due to the fear of repercussions to my career," said Christopherson, who has been waiting since 2004 for a decision on his disability claim.

Beckie Wilson, a retired enlisted sailor and veteran of Desert Storm in 1991, said she gave up seeking VA treatment 10 years ago, opting for private doctors, in part from feeling vulnerable as a woman and made to feel "crazy."

"I didn't feel like the VA is changing so why bother? Is it truly changing? Are you truly trying to do something for us?" she asked.

Such disheartening accounts, and more to come below.

And yet, I do believe that the VA and DoD are attempting to do a better job. The evolution (or is that revolution?) that's necessary in care is an unwieldy, ongoing, steady but still too slow process for those who need the best medical attention ASAP. We need to keep pushing them to improve, giving them the funding and encouragement to continue moving forward.

Scott Huddleston, San Antonio Express-News:

If just “one good person” had helped him, Pfc. Jason Scheuerman might still be alive, the soldier's father told hundreds of military and civilian professionals in San Antonio at the largest suicide prevention conference ever focused on war stress.

“The only one who was ever found culpable for Jason's death was Jason,” Christopher Scheuerman said as the audience saw a photo of him with his son projected onto a screen.

Scheuerman, who testified before a House Armed Services subcommittee in March, said his 20-year-old son was ridiculed by others in his unit before he shot himself in his barracks in Iraq. He called for the military to adopt a “zero-tolerance” policy against supervisors who ignore pleas for help.

“This is an ugly story,” Scheuerman said. “But we have to have the courage to tell these stories as an institution.”

There was an air of candor at the annual DOD/VA Suicide Prevention Conference, sponsored by the Department of Defense and Department of Veterans Affairs. Aside from often being hard to isolate as a cause of death, suicide is an issue many in the military are slow to deal with because of the stigma attached, officials said.

“Stigma kills, and caring leadership saves,” said Brig. Gen. Loree K. Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

In opening remarks Monday at the three-day forum, Sutton told of a sergeant who needed “to talk to someone” after he woke up his wife and kids one night, reliving an attack, after his third combat tour. When he sought help, he was called “a wuss, a wimp and a coward” by his superiors.

“Folks, that is toxic leadership,” Sutton said. ...

The conference, which began in 2002 as an Air Force event, drew 130 people when it was expanded to all four services in 2004, organizers said. It has a record attendance of about 700 in its first year in San Antonio.

Maj. Gen. Mark Graham lost his son Kevin, a senior ROTC cadet in college who took his own life in 2003. Eight months later, his other son, Jeff, was killed by a bomb blast in Iraq. Now, as commander of Fort Carson, Colo., Graham has made suicide prevention and mental health a focal point of his officer training regimen.

Through programs such as ACE — Ask, Care, Escort — for his troops, and “Army 101,” an initiative to teach police, school officials and other civilians in nearby Colorado Springs about the stresses of soldiers and their families, Graham said he's trying to keep troops from falling though the cracks. He said he has support at the highest levels of the Army, but hasn't been able to erase the stigma that lingers servicewide.

We're moving in the right direction, but I think we could move a lot faster,” Graham said. His wife, Carol Graham, said she wished she had done something for their son Kevin, who had told her depression was an illness, not just a sad feeling, shortly before he used a cable to hang himself in his bedroom.

“He just didn't know he could die from being too sad,” she said during a panel discussion of family members.

The Rev. Susan Turley, a VA chaplain in California, said her son, Pfc. Keith Moore, 28, shot himself in Iraq. In e-mails, he grew despondent about a recent breakup with a girlfriend and began questioning the mission. Turley was afraid he'd “hate me forever” if she reported his behavior to the Army.

“I'm not here to blame anybody,” she said. “I have my own guilt and shame as a mother.”

Anne Scheuerman said she reported a suicidal e-mail from her son, a Lynchburg, Va., native, in 2005, and his unit seized his weapon and put him on “suicide watch” in Iraq. He sent her an angry text message, saying, “You just brought down all hell on me,” she recalled. Despite that, she was glad to know he couldn't hurt himself. But the Army determined he probably was faking mental illness in hopes of being booted.

They just think that I want to be sent home. They told me to man up,” he wrote to her. She pleaded with professionals at the conference to listen to service members who ask for help and to give them hope.

“As a mother,” she said, “I am begging you. Take them seriously.”

A companion piece by Huddleston provides more conference details. And on the Army's ACE program:

Previous suicide awareness training emphasized recognizing warning signs, Cornum said. Now the Army is taking that a step forward by getting soldiers to act when they see those signs. “We have to ensure that the Army as a culture and soldiers individually know how to help someone else get through the low points,” she said.

As one way to encourage intervention, the Army is promoting the “ACE” – Ask, Care, Escort -- concept, and has printed up wallet-size cards to explain it to soldiers.

Cornum explained the technique:

  • Ask about (a soldier’s) situation or problem,” she said. “Don’t just sit there and know it. Don’t ignore it.”

  • Care enough to take action.” She urged soldiers to intervene, such as taking a weapon away from a suicidal soldier.

  • Escort the person to a health-care provider or chaplain or unit leader.
“Don’t just make the suggestion that he seek help and then leave,” she said.

“Knowing the ACE technique when someone is suicidal is critical,” Cornum said. “It is just as critical as knowing CPR to prevent cardiac death when someone has a heart attack.”

But just as CPR alone isn’t enough to prevent heart disease, ACE alone won’t prevent suicide, Cornum said. “There are no simple problems and there are no simple solutions," she said. "There is no program that has been shown to be truly effective at preventing suicides.”

Success will be “the sum of a number of smaller steps,” all linked to a broad behavioral health strategy, she said.

“To really and truly prevent death by suicide, we need to … build resilience, increase social competence and enhance problem-solving skills,” Cornum said. “Our goal is to develop an approach that builds lifelong resilience in our recruits, makes them successful soldiers as well as successful citizens long after they leave the Army and makes strong mental health as much of a priority as strong physical health.”

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