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Psychiatric Times.
 

The Military Can Do More To Prevent Suicides

By Allen Frances, MD | October 8, 2012

James Dao reports in the October 7, 2012 New York Times that the military is considering 2 steps to reduce its startling rate of active duty suicides—which is approaching an unacceptable one suicide every day. Both measures are completely sensible, but neither goes nearly far enough.

Privately owned guns and rifles are used in half of the suicides. The military would like to develop a program to engage friends and family in reducing the suicidal soldier’s access to his guns. It seems like the perfectly obvious thing to do. Suicide in the young is almost always an impulsive act—the best form of suicide prevention may be to make it less easily accomplished. This approach is exactly what every mental health worker learns is a vital part of suicide management. In fact, not to try to separate the suicidal person from the suicidal means is sometimes considered a cause for a malpractice suit.

(MORE: Military Mental Health: An Army of Children)

But get this: as it stands now, commanders and military mental health personnel are by law not allowed to do anything about private firearms—even when a soldier is clearly at increased risk of killing himself. How can such foolishness possibly be? Last year the NRA pushed Congress into passing a law that forbids the military from any inquiry into the private firearms of its personnel. Just another obvious example of the NRA’s consistent over-reach beyond common sense or concern for public health and public safety. The American Foundation for Suicide Prevention is promoting a corrective new law, passed by the House but not yet by the Senate, that would restore the military’s right to ask about (but not to confiscate weapons) when there is a high risk of suicide. This a small step in the right direction but it obviously does not go far enough. It seems a no brainer that gun safety for suicidal troops should trump the NRA’s political clout used to subvert even the most obviously necessary forms of gun control.

The military’s second step would be to encourage friends and relatives to remove caches of prescription drugs collected by suicidal troops. It is disturbing to note that 1 in 8 soldiers (110,000) is on a psychotropic drug, and polypharmacy with drug cocktails is rampant. Legal drugs have become a bigger problem than illegal street drugs, and they are they cause more overdoses and deaths. The military needs to go much further. Confiscating caches is far too late in the game. There needs to be re-education on proper prescription habits, greater coordination among multiple prescribers, and much greater control on how pills are distributed.
 

 

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by John McFadden | October 12, 2012 7:37 PM EDT

Tougher screening of applicants may help. Weapons are the lifeblood of the military and our commanders are not babysitters.

by The Editors | November 30, 2012 12:26 PM EST

The following comment is on behalf of Manuel Mota-Castillo, MD:

Let me thank Dr. Frances for lending his prestige to an issue that has been one of my major concerns for the past 4 years.

On 1-26-10, Colonel Philbrick, Director of the Army Suicide Prevention Task Force sent me a letter on behalf of General Peter Chiarelli, the Vice-Chief of Staff. More recently, Secretary Panetta also had the courtesy of answering a communication in which I expressed my concern for what I think the psychiatric community is doing regarding the wave of suicide in the military: namely, ignoring the elephant in the room. We need to face this elephant.

It would be silly to diminish the relevance of the data and possible solutions presented by Dr. Frances. But let's remember that Great Britain also has soldiers deployed in Afghanistan and that their rate of suicide is similar to that in the civilian community. (1) Furthermore, 31% of the enlisted men and women who kill themselves were never deployed to the war front.

Patients with PTSD and bipolar disorder are treated with SSRIs because in the early 90's the establishment decided that Prozac and Zoloft were the magic bullets for this disorder. We now know that antidepressants can cause agitation and increase impulsivity in persons with even mild forms of bipolar disorder.

And there is this sinister view from an Army Major who spoke at a Psychiatric Congress meetings. He said: "Yes, you are right, those symptoms are more compatible with a bipolar diagnosis, but I have the responsibility of protecting that soldier's career…if I say he is bipolar, then he cannot be deployed. And in the Army, if you cannot be deployed, you have to leave the service."The private he was talking about had been given methylphenidate for ADHD at a time when he was showing a hypomanic state, according to what the military psychiatrist discussed during an informal conversation in front of my poster presentation.

Yes, you guessed right. I am saying that bipolar spectrum disorders are many times more prevalent than what we have been lead to believe…instead of relaxing a racing/agitated mind we are pouring gasoline on a brain "touched by fire," as Dr. Kay Redfield-Jamison would say.

I hope other colleagues will join the needed dialogue that Dr. Frances has wisely started because the Veteran Administration still gives sertraline to every patient with PTSD and the Army (personal observation during my brief civilian work with it) is following its steps.

I hope this tragic situation serves as an incentive to psychiatrists to consider helping our enlisted men and women to get the quality service they deserve. We can do this either as active duty officers or as civilian employees.

Manuel Mota-Castillo, MD (www.psychiatricanswers.com )
Lake Mary, FL

1. Frueh C, Smith J. Suicide, alcoholism, and psychiatric illness among union forces during the U.S. Civil War. J Anxiety Disorders. 2012; 26(7):769.

More by Allen Frances, MD

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Wonderful News: DSM-5 Finally Begins Its Belated And Necessary Retreat

Definitive Study Rejects the Diagnosis of “Psychosis Risk” and Finds No Treatment Benefit

Internet Addiction—The Next New Fad Diagnosis

Fighting the Wrong War on Drugs

The Epidemic of Military Suicide

The Military Can Do More To Prevent Suicides

DSM-5 Is A Guide, Not A Bible—Simply Ignore Its 10 Worst Changes

Mislabeling Medical Illness As Mental Disorder

DSM-5 Confirms That Rape Is Crime, Not Mental Disorder

Yet Another Way the Medically Ill Will Be Misdiagnosed as Mentally Disordered

Prison or Treatment for the Mentally Ill

Giftedness Should Not Be Confused With Mental Disorder

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The Military Can Do More To Prevent Suicides

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Military Mental Health: An Army of Children






 
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