Army's Suicide Struggles Continue

By LISA CHEDEKEL And MATTHEW KAUFFMAN, Courant Staff Writers

The suicide rate among soldiers in Iraq remained high in 2006 and could reach record levels for the war, with 22 deaths ruled as self-inflicted and more than a dozen other cases still under review, according to Department of Defense records.

A report this month by the military's Defense Manpower Data Center shows 81 confirmed self-inflicted deaths in the Army in Iraq - 22 more than the number of Army suicides reported by the military through 2005.

The number of confirmed suicides in 2006 matches the number in 2005, when the Army's suicide rate in Iraq reached 19.9 deaths per 100,000, the highest rate since the war began.

With as many as 17 other Army deaths still pending a final cause, the 2006 rate is likely to exceed the 2005 level. The total number of deployed soldiers did not change significantly over the two years and declined slightly during some months of 2006.

Veterans' advocates said the continued increase in suicides was troubling, given that the military has made safeguarding soldiers' mental health a priority. In 2006, suicide accounted for more than one in four of all non-combat Army deaths in Iraq.

Among the 2006 confirmed suicides was Tina Priest, a 21-year-old soldier from Austin, Texas, who killed herself in Iraq after reporting she was raped by a fellow soldier and then being placed on antidepressants, investigative records obtained by The Courant show. An Army psychologist deemed her stable just days before her death.

Steve Robinson, director of government relations for Veterans for America, said he was particularly disturbed by suicides in the war zone because combat troops are supposed to be screened for mental health issues before they join the military, before they are deployed and throughout their careers.

"These people aren't the kind of people that you would think would take this step," he said.

Robinson said the military has made some improvements to mental health care, but needs to do more, including making mental health checks as routine - and free of stigma - as vehicle or weapons inspections.

"This discussion about who's having problems is the same thing as checking out your equipment. You've got to check out the human body system. And they're just not doing it," Robinson said.

Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, said the Army was making a "concerted effort" to reduce the number of suicides in the war zone, including revising suicide-prevention training, with specialized programs targeted to recruits, commanders and deployed soldiers.

"We are always concerned about any suicides. Every one is a tragedy," Ritchie said in a written statement to The Courant.

She said the revised training emphasizes "the importance of taking care of one's buddies. We also remind leaders that they must encourage help-seeking behaviors, recognize warning signs of suicidal behavior, and refer for care, if needed."

Other initiatives put in place recently include new deployment guidelines that expand mental health screening for troops heading to war and set limits on when troops with psychiatric problems can be kept in combat.

The guidelines were issued in November, in response to congressional legislation prompted by a May series in The Courant. The Courant found that some troops with pre-existing mental conditions were being sent into combat and that others who developed problems in the war zone were being kept there, in some cases with fatal consequences.

Investigative records show that Priest shot herself in Iraq in March, days after being diagnosed and treated for "Acute Stress Disorder consistent with Rape Trauma Syndrome." The records show she was prescribed the antidepressant Zoloft, the antipsychotic Seroquel and the sleeping aid Ambien.

Her family reported that she was in good spirits before her deployment, the records say. But friends and relatives told investigators that Priest's mental health declined sharply after the rape, and particularly after the soldier she accused was not confined pending his trial.

"Priest stated that she can't do it anymore, that she just wanted everything to be over with," a fellow soldier told investigators, recounting a conversation with Priest days before her death.

Earlier this month, The Associated Press reported that an Army private charged with raping a young Iraqi woman and slaughtering her family last year was found to have "homicidal ideations" by a combat-stress team, three months before the attack, but was prescribed an antipsychotic and retained in combat.

Top Army officials have been watching the suicide rate in Iraq closely since the early months of the war, when a spike in self-inflicted deaths prompted them to assemble a team of experts to examine ways to improve the mental health care of deployed troops. When the number of suicides dropped in 2004, to 10.5 deaths per 100,000 troops, military leaders credited their renewed prevention efforts.

But when the numbers climbed back up in 2005, Army Surgeon General Kevin C. Kiley and others downplayed the significance of the suicide rate, saying they expected some variation from year to year.

Still, at a Pentagon briefing last month, Army officials made clear that they hope to see suicide numbers fall off in 2007, as the new deployment policy and other initiatives take effect. They said they had appointed a suicide prevention coordinator for Iraq, and were in the process of establishing a unit that will more closely analyze each suicide.


Kiley and Col. Edward Crandall, head of the Army's team of mental health experts, have said they believe that most suicides are triggered by relationship and other personal problems, and that troubled soldiers are receiving appropriate care in the war zone.

Because the military does not identify victims of suicide, it was not clear how many of the soldiers who killed themselves in 2006 were serving second or third tours in Iraq, and how many were deployed for the first time.

A December report by the mental health team found that soldiers surveyed in 2005 - especially those who had served more than one deployment - were more likely to report acute stress symptoms than those surveyed in 2004. The Courant's analysis of 2004 and 2005 suicides had found that some soldiers had exhibited clear signs of combat-related stress before they killed themselves, while others had serious mental health problems before they deployed.

The mental health survey found that the stigma associated with seeking mental health care was lifting, with fewer than 30 percent of soldiers worried that they would be perceived as weak. But more than half the soldiers surveyed also said the suicide-prevention training they received was not sufficient to help them identify fellow soldiers at risk. And, complicating the military's efforts to improve services to soldiers, about a third of the mental health care providers serving in Iraq reported experiencing a high "burnout" level.

Jay White, a former Army combat-stress counselor from Cromwell who recently returned from Iraq, said he battled burnout during his second deployment.

"I know that I definitely experienced it. No doubt about that," said White, who now counsels returning veterans at the Hartford Vet Center in Wethersfield. "You don't feel like going to work. You wish you could call in sick, but there was never any of that. Or you'd see people and you're like: `Oh my God, I don't feel like talking to anybody today.' You'd just rather go hide in your trailer or something."

White said he saw evidence that some soldiers with pre-existing mental health problems were being sent into combat - a problem highlighted by The Courant, which found that fewer than 1 in 300 service members saw a mental health professional before shipping out, despite a congressional order that the military assess the mental health of all deploying troops.
"You can't help but wonder what the screening policies are before sending people over," White said. "There are people who have personality disorders - maybe they're just more mild [so] they're not seen before they get there - and then they get there and you're like, `Whoa, this is somebody who probably shouldn't be here in the first place.'"

The new deployment guidelines issued in November include a directive that troops who develop mental health problems during combat tours should be sent home if their conditions do not significantly improve within two weeks of treatment. It also directs that troops with mental illnesses not expected to resolve within one year should be considered unfit for military duty and evaluated for discharge.

Because the guidelines are still relatively new and allow clinicians considerable discretion, it is not clear how they are being applied. A task force headed by Kiley is expected to make recommendations for further improvements to mental health screening and treatment when it issues a report to the secretary of defense this spring.

The Army's 2005 suicide rate in Iraq was higher than the rate of 18.8 deaths per 100,000 troops in 2003, when the spike in suicides had prompted alarm and action from Army mental health officials. The 2006 rate also is expected to exceed the 2003 level.

Throughout the Army, the suicide rate rose from 10.8 per 100,000 troops in 2004 to 13 in 2005, the highest level since 1993.

The military this month released details of a separate, military-wide 2005 survey showing high levels of stress and depression among active-duty service members - both those who have deployed and those who have not. The survey of more than 16,000 service members found that those who had deployed in the previous three years had greater stress, higher rates of depression and anxiety, more alcohol and drug abuse and twice as many suicide attempts.

In recent months, Army officials have enlisted the help of a network of clergy to watch for warning signs of suicide. In an August letter to Army chaplains, Maj. Gen. David H. Hicks, the chief of chaplains, said an "increase in suicidal behavior on the part of our soldiers suggests that the pressures on our Army may be greater than ever." He urged chaplains to assist commanders, soldiers and families in learning to "recognize warning signs and identify at-risk people. One suicide is too many."

Contact Lisa Chedekel at lchedekel@courant.com.