THE PENTAGON — The Navy is rethinking how it addresses suicides after two years of rising rates in the service. While there’s wide recognition among the senior leadership of the problem, quick fixes don’t exist and resources are stretched thin.
Increasing access to mental health providers and training sailors to spot people at risk of committing suicide are critical components for lowering the service’s suicide rate. However, the Navy’s vast geographic footprint, isolated duty stations and the nature of the job complicate the service’s ability to provide mental health care. Additionally, predicting suicide is just not easy, Capt. Tara Smith, a subject matter expert assigned to Navy’s Suicide Prevention Branch (OPNAV N171), told USNI News.
“It’s not something you can identify with a genetic marker. These are individuals with complex problems and complex backgrounds and different resources that deal with them. So, it’s very difficult,” Smith said.
By the nature of what the Navy does, the service has some challenges when it comes to providing health care in general. The force is distributed globally, often at very remote locations at sea or at forward bases.
“Preventing suicide isn’t just about providing more mental health professionals. The primary prevention is really about changing the culture in the Navy. It’s about seeking help and it’s ok to have problems,” Smith said. “Building more trust, building more connectiveness among sailors. Making our sailors more resilient, giving them the tools to bounce back – because we don’t want the military to be less stressful, it is the military, but we do want you to do better handling it.”
“Suicide is best understood if we look at it from a decision paradigm and less than a mental health paradigm,” Craig Bryan, the executive director of the National Center for Veteran Studies at the University of Utah, told USNI News.
Legal issues, relationship issues, job issues, uncertainty about the future – these are all examples of stresses that cause people to make potentially deadly decisions, Bryan said.
“And you have a loaded weapon, and you get overwhelmed in the moment, you make a decision and then there’s no coming back. And that has nothing to do with mental illness.”
For the sailors who die by suicide, Smith said they likely were trying to solve some stress issue – a souring relationship, poor performance report, financial hardship, loneliness – but they did not have the proper coping skills to deal with the stress.
“The primary reason sailors don’t seek help is because there’s a desire in the fleet to handle it themselves, figure out their problems and solve it on their own. To ‘man up,’” Smith said.
The November death of Vice Adm. Scott Stearney, commander of U.S. 5th Fleet, is indicative of this Navy culture, suicide researcher Dr. Melinda Moore, a clinical psychologist and assistant professor in the Department of Psychology at Eastern Kentucky University, told USNI News. Sailors feel the need to hide their problems instead of seeking help because they fear seeking help will jeopardize their security clearance, job qualifications or even their ability to continue serving.
“We know there are a lot of people who are suffering in silence,” Moore said. “Where does somebody like an Adm. Stearney turn if he’s really in distress?… That has to be the loneliest job.”
Smith is trying to change that culture, where Navy personnel understand seeking help is a good thing. “It doesn’t automatically mean the end of our career. It means we’re going to get you the resources you need,” Smith said.
Still, four months after Stearney’s death, an official cause of death has not been announced for what many believe was a suicide. Navy investigators told USNI News their investigation is continuing. Still, the uncertainty surrounding the death of a senior and high-profile leader raises concerns with Moore.
“Adm. Stearney’s death is a problem,” Moore said. “I think the very presence of his death is a problem for the Navy. There needs to be more of a concerted effort for help-seeking.”
The Recent Trend
The Navy’s 2018 active duty suicide rate of 20.1 per 100,000 service members is in line with what the other service branches experienced and was a slight decrease from the Navy’s 2017 rate of 21.4 per 100,000 service members, according to the data from the service.
In comparison, the Marine Corps’ suicide rate among active duty personnel was 30.7 per 100,000, according to the Marine Corps. The Pentagon has not released an official 2018 suicide report, but several media outlets, including military.com, reported the Air Force suicide rate was 18 per 100,000 and the Army suicide rate was 29.8 per 100,000 for the year.
“Suicide across the military is increasing, and it’s increasing in society as well,” Smith said. “Unfortunately, we are a reflection of society and we take sailors from all walks of life, and suicide across the nation has been increasing.”
Nationally, the suicide rate has also been trending upward, to 14 per 100,000 residents in 2017, the most recent year national data is available. However, the suicide rate among men between the ages of 25 and 44 was 26.2 per 100,000 in 2016, the most recent year analyzed by the U.S. Centers for Disease Control and Prevention.
Suicide research is difficult because funding for research is tight and the number of suicides reported each year is relatively small, Julie Cerel, a clinical psychologist and professor in the College of Social Work at the University of Kentucky, told USNI News. With such a small sample group, it’s hard for researchers to determine if a trend is developing or one year is an outlier.
“The reality is, virtually nobody has all the answers. The common response is for people to try figuring why, but in organizational settings, it leads to a lot of finger pointing,” Cerel said. “I think it’s more about what are the stressors and what is the breaking point for people.”
“I would be lying to you if I said we had every location covered with mental health resources. We do not,” Smith said. “We certainly need more mental health resources in the military, and we’re addressing that.”
Smith described several initiatives the Navy is starting to both increase awareness of signs that someone might be in distress and make seeking mental health care more palatable.
For starters, the Navy included mental health questions as part of the annual physical examinations. Mental health providers are being embedded with commands so they can get to know crews.
“We’re starting to make it more common to talk about these mental health issues,” Smith said. “We’re also starting to have mental health providers directly at primary care so that a sailor doesn’t have to go to mental health; they can get mental health right next door to their primary care provider without having to worry about the stigma and fear of being seen walking to mental health.”
The Navy is also working to better use the resources already on hand, Smith said. This includes training chaplains and general duty corpsmen and medical officers to understand situations that could mean a sailor is contemplating suicide. The Navy is also providing training to command leaders, division heads, legal staff and anyone who might come in contact with a person dealing with a stressful situation.
“We’re doing our best to not just hire more people, but what can we do with the assets we have,” Smith said.
For those sailors who seek help, Smith said the treatment appears to work. Out of the sailors who die by suicide each year, only about a third ever walked into a mental health clinic, she said. The challenge is connecting more sailors to a means of dealing with stress in their life.
The military is doing better in many ways than the civilian world because they have the recourses that aren’t available in the civilian world, Cerel from the University of Kentucky said.
Something all branches of the military need to consider, Cerel said, is that many of the people who choose to join already have a lot of baggage. Then, once they join, they’re moved around the country or world and become isolated from family and friends.
To address the problem of isolation, Smith promotes the Give An Hour Program which connects civilian mental health providers around the country with individuals who need help. Smith said this program is especially useful for sailor located overseas. They might not have easy access to mental health on base, but if they can get online they can access a psychologist or social worker stateside who donates time to be part of the program.
“We are making sure resources are available, but if the sailors don’t trust us, that we are genuinely invested in them, they’re not going to speak up,” Smith said. “So we’re trying to teach the importance of being shipmates, and camaraderie, having that trust in each other. Analyzing some of the negative perceptions that we have in seeking help for suicide.”
Suicide Prevention Resources
The Navy Suicide Prevention Handbook is a guide designed to be a reference for policy requirements, program guidance, and educational tools for commands. The handbook is organized to support fundamental command Suicide Prevention Program efforts in Training, Intervention, Response, and Reporting.
The 1 Small ACT Toolkit helps sailors foster a command climate that supports psychological health. The toolkit includes suggestions for assisting sailors in staying mission ready, recognizing warning signs of increased suicide risk in oneself or others, and taking action to promote safety.
The Lifelink Monthly Newsletter provides recommendations for sailors and families, including how to help survivors of suicide loss and to practice self-care.
The Navy Operational Stress Control Blog “NavStress” provides sailors with content promoting stress navigation and suicide prevention:
NavStress social media: