On April 22, 2022, Master Chief Petty Officer Russell Smith, the Navy’s highly decorated top enlisted leader, addressed crew members on the USS George Washington docked for a multi-year overhaul in Newport News, Virginia. Smith was there to listen, learn, and share words of encouragement after three crew members died of suicide in a single week.
While the ensuing conversations touched on many factors impacting the wellbeing of those onboard, the difficulty of accessing mental health services was a pervasive theme. Discussions also touched on the military environments that can strain mental health and the importance of wellness imperatives to ensure that service members can fulfill their duties.
Of course, the growing incidence of suicide and the difficulty of accessing mental health services is not confined to the military. Last December, US Surgeon General Dr. Vivek Murthy surprised many when he issued an alarming advisory on the extent of the mental health crisis facing the nation’s youth. Today, depression and anxiety are at an all-time high in many sectors of the civilian population, but the situation facing our armed services is particularly grave.
During this year’s Mental Health Awareness Month, the Defense Suicide Prevention Office reported that the active duty US Army suffered more suicides in 2021 than in any year since the attacks on 9/11. It was the highest suicide rate since the Great Depression. Brown University’s Cost of War Project compared the increase in military suicides to another heartbreaking number. Since 9/11, 30,177 members of the US military committed suicide. That’s more than four times more than the 7,057 killed in military operations during the same period.
The factors contributing to these statistics – each with a person and family behind them – are many and varied just as in the civilian world. The social isolation caused by the pandemic, substance use disorders, and even macro-economic trends impact military families too. But service members face an onslaught of additional challenges.
Violence encountered in war zones is traumatic, and the sense of selflessness that prompts our soldiers, sailors, and airmen to put themselves in harm’s way is often marked by an unspoken commitment to “soldier on” that can make it difficult for many to share mental health concerns or get help. Combat is also different today. For example, the increased use of improvised explosive devices creates an environment of constant fear.
Service members and their families face additional challenges of the battlefield as well. Numerous deployments, constantly moving to new places, and long stretches when a spouse, parent, or child are away, all jeopardize the mental and emotional health of those who serve and their loved ones. Even living conditions, such as those discussed on the USS George Washington, can be problematic – a reality that prompted the Government Accountability Office to recently examine steps that should be taken to prevent suicides at remote installations.
Making a difference with an integrated approach.
Clearly, there is no single solution that will ensure the emotional wellbeing of our service members. As seen in civilian populations, the most impactful approach to care for the military has been found to be one that is viewed as part of a larger integrated process.
Elements of this integrated process include readily available non-medical short-term counseling, fast and timely direct clinical interventions; and the use of digital solutions that enable fast access to help and enable individuals to develop the coping mechanisms, behavioral health strategies and habits required to achieve positive long-term outcomes and overall wellness.
Non-medical short-term counseling services are easily accessed by phone and in-person on bases and address a wide range of topics, including anxiety, stress, loneliness, family relationships/dynamics, and other issues. Counselors can also provide actionable insights and education on mental health issues common in military life related to changes in stations, deployments, family reunions, and other day-to-day realities.
Importantly, these same services should also be available to all family members. Not only does this address the needs of loved ones – a key factor in the health of military families – but it also facilitates early detection and prevention. Family members are often the first to know when a soldier, sailor, or airmen is struggling with a mental health issue and often are instrumental in getting them to help.
Immediate referrals and direct clinical interventions, when needed, also ensure that service members and their families get help when counseling is not enough. This includes fast access to psychologists, substance abuse experts, and experts trained in the treatment of post traumatic stress disorder (PTSD ).
Even in the best of circumstances though, counselors and clinicians are not always present. For example, even if a counselor meets with an individual soldier every day for an hour, that still leaves 161 hours of unsupervised time each week. This is vital because it is in these moments when help can be truly crucial. One study found that nearly half of those who attempt suicide do so impulsively in the moment.
To address that reality, service members and their families can also be given access to a suite of self-service, personalized digital health tools. Accessed via an application on their mobile phones, they help individuals rapidly access assistance and develop the habits required to achieve long-term wellness.
Highly proactive, the application prompts the individual for insights – for example asking the service member about stress levels and anxiety and prompting them to complete coping actions that can be therapeutic – such as brief meditations, breathing exercises, journaling, and other activities. Enabling frequent , high-touch engagement, the application also creates a 24/7 safety net. The application can immediately put the individual in touch with a counselor, provide referrals, or facilitate a clinical intervention.
Simultaneously, the technology also provides an anonymized, real-time view into population health at the base level. This helps leaders identify conditions that are causing mental health issues before they become endemic at a particular facility.
It is our hope that this integrated approach will ultimately offer lessons that can be shared with the many organizations that are working to better serve those who serve us. In May, we celebrated the importance of Mental Health Awareness and Military Appreciation Month. Then on Memorial Day we remembered those who made the ultimate sacrifice. Now, more than ever, it is important that we reflect on both, not just during one month, but always.
Photo: SDI Productions, Getty Images