AJPH Supplement on Military Suicide

As coordinators of a civilian network serving active-duty GIs,^1,2 we comment on the Supplement about military suicide.³

First, the epidemic’s magnitude deserves greater emphasis. Eighteen veterans kill themselves daily.⁴ An average of one active-duty GI commits suicide every 1.1 days.⁵ More GIs deployed to Iraq and Afghanistan will die from suicide than from combat.

Despite further data about the epidemic, few articles in the Supplement describe interventions to reduce suicide. The Supplement presents no causal evidence that these well-meaning efforts have impacted the epidemic significantly. Concerns pertain to the Supplement’s external funding from the Department of Veteran Affairs, the substantial editorial role played by people working for the military or other branches of government, and the lack of explicit attention to possible conflicts of interest.

We are not optimistic about improved military policies regarding mental illness and suicidality. Despite the Hippocratic requirement to address the client’s needs first and foremost, military professionals also must consider how to maintain combat forces.⁶ The resulting double agency leads to breaches in confidentiality, belittlement of distress, and distrust.

Harassment continues to occur when GIs seek help for mental health problems, including suicidality. Our recent clients report stigmatization, marginalization, and other adverse reactions from commanding officers. “Suicide watch” isolates GIs from their units and subjects them to humiliation.

Outsourcing and privatization exacerbate such problems. Barriers to neuropsychiatric and other specialty consultations result from the reluctance of managed care organizations (MCOs) contracting with TRICARE (the health care program for active-duty personnel and their families) to pay for these referrals. Such contracts have become so lucrative that the executive who benefited most from the Iraq war headed an MCO, rather than a military-industrial corporation.⁷

Civilian programs can counteract double agency, harassment, and distrust. Our network, another national organization,⁸ and several regional initiatives have offered services, usually on a voluntary basis. Veterans’ organizations opposed to the wars have initiated coffee shops and other outreach programs near military bases.

Most of our suicidal clients lack a coherent narrative to justify the traumas that they have suffered and inflicted (although some cite the advantages to corporations that extract oil or rebuild infrastructure⁹).

In that context, the Supplement conveys an ideology that fosters resiliency among those suffering from war, rather than analyzing war itself as the fundamental public health problem. Consistent with an official APHA policy statement,¹⁰ a more effective public health strategy would focus upstream on preventing the wars that generate the epidemic of suicide.