Step 1 to end military suicides

This week is National Suicide Prevention Week, and we’ve invited John Bateson to write a series of articles on one group that is particularly vulnerable: military service members. The first part of the five part series follows.

Fifteen years ago, the suicide rate among patients in a large behavioral care system in Detroit was seven times the national average. Then leaders there decided to tackle the problem. The first question asked was what should be the goal—to cut the rate in half, reduce it to the national level, or more? One employee said even a single suicide was unacceptable if it was your loved one, and that helped set the target: zero.

It might seem unrealistic, but the behavioral health services division of the Henry Ford Health System proceeded anyway. Dr. C. Edward Coffey, who headed the effort, found that rather than being daunted, employees were energized by the goal, so much so that pursuing perfection became an integral part of the system’s clinical care. Coffey notes today that if 99.9% accuracy is good enough, then 12 babies in this country will be given to the wrong parents every day, 18,000 pieces of US mail will be mishandled every hour, and two million tax records will be lost every year by the IRS.

In four years, suicides at Henry Ford were reduced by 75 percent. This was good, but not good enough. With more work, the rate went down to zero and stayed there, at last count, for two-and-a-half years. How?

• Every time a patient sought care, regardless of the reason, he or she was assessed for suicide risk, with specific interventions crafted for each of three risk levels.
• Every employee who came in contact with patients had to take a course in suicide prevention and score 100 percent on a test—perfection—or retake it.
• Policies were implemented to provide timely care by enabling patients to get immediate help through email consultations with physicians and same-day medical appointments. Patients could get prescriptions filled the same day they were called in, too.
• Protocols were developed to remove weapons from the homes of suicidal patients.

It was a huge commitment, but showed what was possible. A similar commitment by the military could achieve dramatic results, at least among active-duty troops. These troops are in the system now, their activities are monitored every day, so there are numerous opportunities for assessment and treatment.

If the military followed the Detroit model, all troops would be evaluated for post-traumatic stress and suicide risk when they returned home, not just those who asked for help. Evaluations would be in person and one-on-one, not done in a group with written questionnaires, as has been the practice in the past. In addition, evaluations would be conducted multiple times up to three years following deployment to allow for delayed reactions. Family members would be interviewed as well, separately and confidentially.

Despite throwing millions of dollars at the problem—far more than is spent to prevent civilian suicides—the military continues to experience a staggering number of deaths. Every day an active-duty service member dies by his or her hand, and every hour a veteran does the same. The time has come for officials to demonstrate a genuine commitment to end military suicides. Not just reduce them, but end them. Following Henry Ford’s lead in Detroit would be a good start.

Featured image: Departure Ceremony by The US Army. CC BY 2.0 via Flickr.