Current Dept. of Defense policy requires doctors to tell commanders about mental health issues with their service members under circumstances shes says are vague. At Wedesdnay's hearing, Gillibrand suggested that's a deterrent because service members worry about repercussions to their career. Photo courtesy of the Office of Sen. Gillibrand

Dec 09, 2019 — The rate of death by suicide has increased about 30 percent in the last twenty years. It’s high for veterans and active military, too. On Wednesday, Sen. Kirsten Gillibrand (D-NY) and Sen. Thom Tillis (R-NC) convened the Senate Armed Services subcommittee on personnel.

Five experts testified about the high rates of suicide among active duty service members and veterans.

One of them was Matthew Miller, a clinical psychologist, who served in the U.S. Air Force. 

“Within my position, I’m often asked ‘why’ in the context of suicide," Miller said. "I’ve asked this question myself for several years after losing my friend and my colleague, a marine Cobra driver to suicide during OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom).”

That hit Miller hard. He ended up leaving the military. But a few years ago, when issues with suicide among veterans started coming up more in the news, he says he was compelled to go back. Now, he heads up the suicide prevention program at the Department of Veterans affairs.

“In my quest to learn what I may have done wrong or what I may have missed with John, it’s become clear to me that suicide is a complex issue with no single cause,” said Miller.

Suicide among veterans is often attributed to post-traumatic stress disorder (PTSD); suicide is much lower among veterans who get help from the VA or VHA. But, Miller and the other experts at Wednesday’s Senate hearing say the contributors to suicide can’t be simplified to just PTSD. Gillbrand said part of it comes from the difficulty of having to sacrifice taking care of your family in service of a mission.

"If the military is able to understand how the day-to-day stressors of serving can impact service members, they can work to minimize those stressors based on mission requirements and create the systems service members need to be successful," said Gillibrand.

The Department of Defense has started teaching young service members skills to deal with daily stressorsand  trying to keep strategies relevant.

"For example, identify and supporting people at risk. We will be teaching young servicemembers how to recognize and respond to suicide red flags on social media to help others who might be showing warning signs," said Karin Orvis, director of the Defense Suicide Prevention Office at the DOD.

Check out the full subcommittee hearing:

The experts agreed there’s no single cause and no single solution to the problem, but they do know suicide is usually precipitated by mental health issues like depression and anxiety. According to Dr. Ron Kesler, professor of healthcare policy at Harvard Medical School, those issues usually first come up when people are about 13 years old.

"What we need to do, one thing that would be of enormous value would be to develop more focus at the early end of the spectrum rather than late end of the spectrum. Let’s not wait until they’re jumping off the bridge and Matt Miller’s guys try to grab them back," said Kesler.

"If we can find people who have relatively mild problems and get them into treatment early enough, that would be of enormous value."

Kesler suggested other concrete ways to address the high suicide rate: the DOD could do an "inception survey" of people as they enter the military to find out about their history of mental illness, so they can respond more quickly; and better evaluations of matching mental health treatments to patients’ individual needs.

Suicide isn’t only a problem in the military, of course. Kesler says the Departments of Defense and Veterans Affairs are well-equipped to look for solutions for everyone because they’re among the largest health systems in the country.