Suicide and How it Impacts Military Families

Suicide and How it Impacts Military Families

Description of the Case or Problem

As the number of suicides amidst the U.S. Armed Service members have constantly increased in the past decade, so has the rate of survivors affected by military suicide, leading to loss of life. Whenever a loved one loses their life as an outcome of suicide, the resulting trauma and shock might compromise the survivors' physical and mental health. This leaves the victims more susceptible to a more agonizing and intricate grief process. Those individuals bereaved by suicide are at an increasing danger of also committing suicide. Peer encouragement, a recognized recuperation method from addictions and sickness, has been clinically monitored to be broadly used by the suicide loss survivors. Researchers have given minimal interest to effective interventions for the victims of suicide loss in the general U.S. population; less is recognized regarding the efficiency of peer support amidst survivors of a U.S. military suicide loss of life (Harrington-LaMorie, 2011).

Lasting effects are imposed by military suicides on survivors whose lives are permanently changed (Shneidman, 1972, p. xi). For every individual that dies via suicide, conservative approximations are that six people with close relationships to the deceased are directly impacted (American Association of Suicidology, 2010). Regardless whether the death is through indirect or direct actions of self-destruction, suicide is usually encountered as an abrupt, traumatic loss. With every suicide death of a service member, allies, military families, and significant others are greatly affected spiritually, socially, emotionally, as well as physically, in its repercussion. The abruptness of the loss frequently crisscrosses with a stigmatizing sorrow, making the suicide survivors' loss more susceptible to an upsetting, secluded, and intricate grief process. The literature proposes that survivors impacted by suicide loss fight with more strong and prominent "thematic issues" (Jordan, 2008, p. 680) like social seclusion, embarrassment, guilt, traumatic symptoms, apparent rejection, complex grief, and their own suicidality, contributing to the susceptibility of the survivor to constant distress and psychiatric disorders (Cerel, Padgett, Conwell, & Reed, 2009).

Military workers have lost their lives to suicide, whether in battle or at peacetime (Harrington-LaMorie & Ruocco, 2010). Suicide in military has been present since the existence of standing armies (Defense Health Board, 2010, p. 11). According to history, suicide rates at peacetime are normally less than the U. S civilian suicide rate by 50% to 55% and 20% to 30%, respectively (Kang & Bullman, 2008). Presently, with the suicide rates increasing amidst all service branches of the U.S. Armed Forces, the necessity to increase suicide avoidance, intervention, and post-intervention are a crucial mental and health catastrophe experienced by the Department of Defense (DOD). Ever since the interception of the disagreements in Iraq (2003) and Afghanistan (2001), there has been a disturbing increase in the suicide rates in active-duty armed services workers (Harrington-LaMorie & Ruocco, 2010). The suicide rate for every service started increasing in 2002, with the most frequent manner of death being a self-inflicted gunshot injury (Kang & Bullman, 2008). 41% of these deaths were documented as utilizing non-military issued guns (Defense Health Board, 2010).

The U.S. Army and Marine Corps have experienced the most deployments and exposure to war in both Afghanistan and Iraq, since the battles started. Presently, both of these service branches have had the highest increase and constant spike in suicide rates. The question of how best to assist suicide survivors remains an issue of concern (American Foundation for Suicide Prevention, 2010, p. 2). Even less is recognized, regarding treatment and prevention for survivors.

This paper analyses the issue of suicide in the military, the associated theoretical framework, factors which can assist explain the issue, policy, remedies/interventions and the legality / ethicality of the issue.

Related Theoretical Framework(s)

Though a lot of studies have been conducted on suicidal behaviors in a theoretical context, theories of suicide spanning different outlooks have been suggested. According to biological theories, suicidal behavior is an outcome of the dual presence of a biologically-founded diathesis as well as an activating personal stressor. Psychodynamic theories suggest that suicide is a result of unconscious forces, strong affective conditions, longing of breaking out from psychological hurt, existential drives for purpose, and disturbed connection. Cognitive-behavioral theories put forward casual roles for despair, the suicidal cognitive mode, shortage in autobiographical memory and views of entrapment, and emotional dysregulation. Systems/developmental theories put forward casual roles for disturbed family systems and social forces (Orden, et al., 2011).

The Interpersonal Theory of Suicide

Suicidal behavior is one of the main issues globally that has gotten relatively minimal empirical attention. The relative absence of empirical attention might be partial because of a relative lack of theory development concerning suicidal behavior. The most risky kind of suicidal desire is as a result of simultaneous presence of two interpersonal constructs (apparent burdensomeness as well as dissatisfied belongingness), and additionally, that the ability to engage in suicidal behavior is separate from the longing to engage in suicidal behavior. In accordance to the theory, the ability for suicidal behavior appears, through habituation and opponent procedures, in reaction to constant exposure to physically painful and/or fear-provoking encounters. The basis of the interpersonal theory is the presumption that individuals lose their lives by suicide since they could and wish to. Within the theory's outline, three constructs are vital to suicidal behavior; two mainly associated with suicidal craving (apparent burdensomeness as well as dissatisfied belongingness) and one majorly associated with the ability (obtained capability for suicide). In addition, the theory incorporates a specification of a casual conduit for the development of the longing for suicide and the ability to take part in grave suicidal behavior (Orden, et al., 2011).

Multidimensional Grief Theory

This theory is founded on a developmentally conversant multidimensional start of grief. Its content areas include and stretch beyond the existing models of both pathological and normative grief (including the newly proposed DSM-5 Persistent Complex Bereavement Disorder criteria; American Psychiatric Association 2012). These content areas are: Separation Distress, Distress over the repercussions of death, and Identity/Existential-Associated Distress. This theory is founded on the presumptions that both positive adjustment and mal adjustment could be evident in every content area; that varying content areas might differentially relate to varying casual precursors (like outcomes of death, and mediators), casual repercussions (like functional destruction and developmental derailment), and moderators (like developmental culture and phase); and that positive and negative adjustment procedures could and often do co-happen within and across content areas (Kaplow, Layne, Saltzman, Cozza, & Pynoos, 2013).

Analysis Indicating the Contextual and Personal Factors That Are Most Relevant for Explaining the Problem

The association amidst military service and suicidal behavior stays intricate. Various historically known risk factors are exposure to trauma, access to deadly means, access to marksmanship education, probable assortment and self-assortment of hostile people, disconnectedness from the support systems, desensitization to stigma and death related with mental health issues and requesting mental health services. These risk aspects as well as recent rises in the military suicide rate imply that suicide risk is possibly an occupational danger of the military service. There exists little study on the impacts of military service and suicide risk.

Treatment Response to It and Policy Change or Advocacy Agenda

President Barack Obama addressed the American Legion's 96th conference and gave a summary of the five priorities of the Administration for restructuring the U.S. Department of Veterans Affairs (VA). Among those priorities is mental health of the service members, experts, as well as their families. The new mental health executive undertakings aspire to enhance the change from the U.S. Departmemt of Defense (DoD) to VA and private healthcare providers, enhance not only quality, but also access to mental health care at DoD and the VA, enhance the treatments of disorders like Traumatic Brain Injury and Post-Traumatic Stress Disorder (PTSD), create awareness regarding mental health and encourage people to seek assistance, enhance patient safety and suicide avoidance, and reinforce community resources.

The Department of Defense shall now automatically register every service member that gets care for mental health conditions in the Transition program of the Department, when they depart from military service. The program assists the people in the process of change to a new care team in the VA, and it was just accessible to the service members that were referred by their Department of Defense provider or who searched and requested for the program by themselves. The VA shall also put into practice a new policy to make sure that the freshly released service members are capable of accessing mental health medicine prescribed by an approved DoD provider, regardless of the fact that the medicine is on the formulary of VA or not.

So as to enhance the access and quality of mental health care, the VA shall lead an extension of metal health peer support to the veterans receiving treatment in primary care settings. DoD shall work hand-in-hand with Congress to bring TRICARE up to complete mental health and drug use disorder equality.

In order to create awareness and encourage people to seek assistance, the DoD and VA are increasing their suicide avoidance and mental health education for healthcare providers, chaplains, as well as workers that relate directly with the veterans. Both the DoD and the VA hope to enhance suicide avoidance and patient safety, through the provision of new opportunities for service members, veterans and their families to return unwanted medicines and to willingly secure their guns. In addition, so as to reinforce community resources for the service members, veterans and the members of their families, DoD and the VA intend to offer existing military cultural expert education to 3,000 community mental health providers in the next year (AFSP, 2014).

Intervention

The kinds of DoD suicide prevention interventions outlined here are crisis lines, gatekeeper training, primary care training services, limiting access to deadly arms, and a thorough suicide prevention program.

Suicide Crisis Lines

The 800 number for the military emergency line is posted by every service on its suicide prevention website. Renamed the Military Crisis Line in 2012, the Veterans Suicide Crisis Line was initiated in 2007 as a charge-free, private resource, which connects service members in emergencies to competent responders. Two after following its initiation, the Crisis Line included an unidentified online chat service and, a text messaging service in 2011. The Military Crisis Line is a combined undertaking of the Substance Abuse and Mental Health Services Administration, VA, and DoD.

Gatekeeper Training

This training is simply a generic approach, which educates certain groups of individuals on how to recognize those surrounding them that are at a great risk for suicide, and later on, refer those individuals for treatment. The two most well-known gatekeeper training programs are funded by the Army: Applied Suicide Intervention Skills Training (ASIST) and Ask, Care, Escort (ACE). The former uses health experts, clergy, or officers, while the latter utilizes peers as the gatekeepers.

Primary Care Training and Services

Though not particularly meant to avoid suicides, one extensive DoD program designed to support acknowledgment as well as high-quality depression treatment and PTSD in primary care, RESPECT-Mil, possesses the elements of effectual suicide prevention. In accordance to a powerful review article, primary care provider awareness is one of the two kinds of suicide prevention programs. Primary care provides a useful chance for the prevention of suicide, since majority of the suicidal patients have contact with their primary care providers in the months prior to their death, and since entering primary care is regarded as less stigmatizing when compared to entering specialty care.

Restricting Access to Lethal Means

Studies reveal the clear association between firearm ownership and increased suicide rate. A new population-founded study of veterans discovered that they were twice as likely as the non-veterans to die by suicide, and 58 more probable, than the non-veterans to utilize guns than other suicide ways to conclude their lives.