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SUICIDES: A TREATMENT ISSUE -- A new Army report

suggests that the quality of care, as much as the quantity

of providers, may be a factor in the rising incidence of

suicides among active-duty service members.

 

 

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Suicides: A Treatment Issue

By LISA CHEDEKEL
Courant Staff Writer

In recent months, the military has scrambled to hire additional mental health workers to treat troubled troops, hoping to allay concerns raised by a Pentagon task force and soldiers' advocates about inadequate access to care.

But a new Army report suggests that the quality of care, as much as the quantity of providers, may be a factor in the rising incidence of suicides among active-duty service members.

A recently released, first-ever analysis of Army suicides shows that more than half the 948 soldiers who attempted suicide in 2006 had been seen by mental health providers before the attempt - 36 percent within just 30 days of the event. Of those who committed suicide in 2006, a third had an outpatient mental health visit within three months of killing themselves, and 42 percent had been seen at a military medical facility within three months.

Among soldiers who were deployed to Iraq or Afghanistan when they attempted suicide in 2005 and 2006, a full 60 percent had been seen by outpatient mental health workers before the attempts. Forty-three percent of the deployed troops who attempted suicide had been prescribed psychotropic medications, the report shows.

The report offers no details on the type or duration of mental health care that troops received before they tried to kill themselves. But it is prompting calls from some soldiers' advocates for better training of medical and behavioral health specialists in recognizing and treating service members in distress.

"It's the patient care, the quality of care, that's the issue," said Andrew Pogany, an investigator for the advocacy group Veterans for America. "A lot of the soldiers I talk to, they say [the military] doesn't provide anything except for group therapy and meds. Some places, you can't even get near a psychiatrist.

"... We need more providers, but the ones they do have, there's a lack of knowledge and a lack of training in how to treat combat-related problems."

In a June report, a Pentagon task force on mental health looked at the issue of quality of care, recommending that the military develop core training for all medical staff in recognizing and responding to service members "in distress." The panel also said mental health providers needed additional training in treating depression and combat stress.

In a response to the task force delivered to Congress last week, Defense Secretary Robert Gates' office agreed with those recommendations, saying training would be expanded.

Col. Elspeth Ritchie, psychiatry consultant to the Army Surgeon General, said in an interview that the Army is revamping its suicide-prevention training for all medical and mental health providers, and is now requiring all behavioral health workers who are sent to Iraq to complete specialized training in combat stress. In addition, the Army in July launched a "chain-teaching" program that aims to educate every commander and soldier about recognizing symptoms of post-traumatic stress disorder and traumatic brain injury by mid-October.

Ritchie said existing training in suicide prevention is "uneven" and needs to be adapted to the combat environment, where situational stressors, rather than long-term depression, can ignite soldiers' distress.

"In the civilian world, depression is the most common reason" for suicide attempts, she said. "In our population, unfortunately, in most cases ... it's a very impulsive act."

Ritchie said she was not troubled by the findings that many soldiers who tried to kill themselves had sought mental health treatment in the weeks or months before they attempted suicide.

"In some ways, there's good news in it ... because it means we're getting people into care," she said. "In the past, when we looked at completed suicides, most had not been seen."

She added, "Clearly, we're not able to prevent all attempts or completed suicides," no matter how well-trained military clinicians might be.

Like soldiers' advocates, some family members of troops who have committed suicide question the quality of care being provided.

Yania Padilla of Bridgeport said her brother, Walter Padilla, was diagnosed with PTSD after he returned from Iraq in 2004. But she believes he never received adequate treatment from either the Army or the Department of Veterans Affairs.

"He saw someone at Fort Carson" in Colorado, where he was stationed, she said. "They told him he was not to be assigned to duties where he had access to a firearm. I don't know what else they did, [but] he wasn't getting better."

Yania Padilla said her brother, a tank gunner who suffered from nightmares, flashbacks and stomach problems, received a medical discharge from the Army in December 2005. He then sought treatment from the Colorado VA. The outgoing, artistic young man who had followed his father into the Army became edgy and distant, his sister said.

On April 1 of this year, while living and working in Colorado Springs, Walter Padilla pressed his Glock pistol to his head and ended his life. He was 28.

After he died, the family found a bag full of prescription antidepressants in his apartment, said Yania, 31, a schoolteacher.

"He never received the kind of help he needed," she said. "I just don't want to see the same thing happen to someone else."

A series in The Courant last year detailed a number of cases in which troops who committed suicide in Iraq in 2004 and 2005 had been seen by mental health workers and placed on powerful psychotropic drugs, with little to no counseling or monitoring. The military in August 2006 adopted detailed guidelines for dispensing psychiatric drugs to combat troops, calling on mental health providers to have weekly contact with patients, during the first weeks of treatment, and to ensure that troops receive psychotherapy.

Walter Padilla is not counted in the Army's suicide numbers, because he had been discharged before he died. The Army does not officially track veterans' suicides.

But suicides among active-duty soldiers have climbed in the last few years. In 2006, soldiers killed themselves at the highest rate in 26 years, with the number of suicides among those serving in Iraq exceeding the record level of 2005. At least 120 soldiers tried to kill themselves while deployed to Iraq or Afghanistan in 2005 and 2006.

The Army has sent combat-stress teams into Iraq to counsel troubled soldiers, but the ratio of providers to troops has dropped in the last two years, even as troops' psychological needs have multiplied. In 2004, there was one counselor in the war zone for every 387 troops; now, the ratio is one for about 740 troops.

Ritchie said the Army is still meeting the staffing level recommended by its mental health experts of one provider per 1,000 troops, but is reviewing whether more help is needed.

"With repeat rotations and stress on the force, we need to look at that ratio. We're doing that now," she said.

The Army is in the process of hiring an additional 265 civilian behavioral health workers, but those new workers will not be sent to the war zone. The corps of deployable mental health professionals is limited, with some already serving second or third tours in Iraq.

Ritchie said the Army is closely tracking soldier suicides in Iraq, which are expected to continue to climb. She said it would be premature to discuss trends in the suicide rate this year.

"We are monitoring the situation very closely," she said.



Contact Lisa Chedekel at lchedekel@courant.com.

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Larry Scott  --