Monday, November 23, 2009

Outside View: Army throws money at mental health

Outside View: Army throws money at mental health

Published: Nov. 20, 2009 at 11:00 AM
By LAWRENCE SELLIN, UPI Outside View Commentator

HELSINKI, Finland, Nov. 20 (UPI) -- The U.S. Army recently funded a five-year, $50 million study by the National Institute of Mental Health to examine the factors possibly associated with suicide, including combat-related trauma, personal and economic stress, family history, childhood abuse, a military unit's cohesion and general mental health.

With all due respect to the eminent scientists at NIMH, I wonder if much of that information is available already from civilian sources, both online and in paper-bound publications. I would doubt that surveying hundreds of thousands of recruits and interviewing soldiers will, in the end, provide that eureka moment they seem to anticipate. Five years seems like a long time to wait for conclusions of which we may already be aware.

There is a humorous aphorism floating around the consulting community, courtesy of, that if you can't be part of the solution, there is good money to be made prolonging the problem. A five-year study has the added benefit that it will likely outlive the tenure of the Army bureaucrats currently responsible for initiating it.

During a Defense Department news conference Tuesday, Army Vice Chief of Staff Gen. Peter W. Chiarelli said: "As I look across all the factors, from the number of deployments individual brigade combat teams have gone through, to everything else, I cannot find a causal link that links anything, other than what the Army Science Board gave me that said that soldiers who are in geographically separated locations -- OK? -- have a higher incidence of suicide. I guess the statisticians can prove that. But I can't find it."

According to the Suicide Prevention Resource Center, a sociocultural risk factor is a "lack of social support and sense of isolation." This can occur when a combat soldier leaves the support network of his combat buddies, when soldiers return home and undergo the often dangerous transition to "normalcy" or even new recruits working under stress in an unfamiliar environment. It is about unit cohesion.

Remedies include strong connections to family and community support, easy access to a variety of clinical interventions and support for help-seeking, effective clinical care for mental, physical and substance use disorders, support through ongoing medical and mental healthcare relationships, skills in problem solving, conflict resolution and nonviolent handling of disputes, and cultural and religious beliefs that discourage suicide and support self preservation.

"I've scrubbed the numbers every way I possibly can," Chiarelli said. "I cannot find a causal link."

First of all, there is no "causal link." Suicide is a process, sometimes fast, but mostly slow. One is carried down a river of emotions with various eddies and currents affecting the direction and speed of the journey. With help, you can be pulled to the shoreline. Without it, you may eventually go over the waterfalls.

Courtesy of The Times of London, one Army wife, whose husband committed suicide, accurately described the process: "It seems to be a perfect storm of issues. Someone comes back with post-traumatic stress disorder. They get into difficulties with money and relationships. They turn to drink or drugs and are unable to ask for help. They feel they are no longer of value to their unit; that the army and their family would be better off without them. That's when they are at risk."

Secondly, I don't believe that we have fully examined the data we have, both structured and unstructured, in an efficient and contextual way. There are highly sophisticated information technology tools and methods to do that right now both quickly and effectively by a combined analysis of biopsychological, environmental and sociocultural risk factor with known pre-suicidal symptoms and how they match with soldiers' experiences.

It is interesting to note that in a study titled "Is Suicide at MIT a Poisson (random) Process?" the authors with only a sample of 33 were able to statistically demonstrate that suicides were most related to stress during or after exam periods. Yes, it appears obvious, but that is my point, because I do not think the Army has done a rigorous analysis of the data that are already available.

Col. Elspeth Ritchie, the Army's lead psychiatrist, was asked in a 2009 Salon interview if she has had the opportunity to query enlisted soldiers, personally, in an off-the-record environment by strolling the barracks or hanging out in a hospital smoking area. She said no.

The Army's senior officers need to lead from the front, try to get to know their soldiers better and spend enough time with them such that they feel that you know and care about their stresses and difficulties.

The Army's mental-health challenge will be won more quickly and effectively by leadership rather than through cash or complacency.


(Lawrence Sellin, Ph.D., is a colonel in the U.S. Army Reserve and a veteran of the conflicts in Afghanistan and Iraq.)



It's not often I will agree with an Army PHD on issues like this, but Colonel Sellin is accurate, if the Army's top mental health doctor does not have enough sense to walk around the smoking area of a Army mental health clinic, or sit at the PX snack bar and listen to the soldiers talk about the problems they are dealing with, because they do talk, I have spent enough time in all of those places during my 15 years of Army service, better yet spend an hour a week at the NCO club at the bar and just watch and listen, they could learn a lot in a week or two, and it would be more beneficial to the Army and the soldiers in it now than to wait for a 5 year new study to be completed. but as long as the study is going on the Army can claim they are "doing something" while nothing gets done.

My experience is from the Vietnam War era (I served on the DMZ in Korea) and Gulf War One, I served with a lot of NCO's that have PTSD, I saw a lot of soldiers get thrown out on PDO discharges when they shouldn't have been. I am 11B3M a combat infantryman for mechanized vehicles (M113) I entered the army after I enlisted a PV1 in 1973 and was a Staff Sergeant on the SFC list when I left active duty in 1982. I was a member of the Georgia National Guard when activated for GW1. I was also a med vol at Edgewood Arsenal in the summer of 1974, I am pretty sure Colonel Sellin might be familiar with that program and what it entailed, now talk about nightmares, read up on the CIA liason Sidney Gottlieb the master of disaster....

Yes, soldiers and their families need help, not more studies the NIMH and and NCPTSD have all the data they could ever want, they just need someone that can read and comprehend what they are reading.

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