Mental Health Awareness Month: Confronting Suicide in the Military Featuring Dr. E

Help is available. If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.


According to the U.S. Department of Veteran Affairs, in 2019 (the most recent data), every single day, approximately 17 U.S. veterans die by suicide, which is about 150% more that of nonveterans. What’s more, the suicide rate for women veterans was 220% higher than the that for nonveteran women.

When it comes to active military, death by suicide is four times higher than deaths in war operations since September 11, 2001. What’s more, military suicides are up 16 percent in 2020, but officials don’t blame pandemic.


What’s going on?

Death by suicide is rarely the result of one factor. Instead, it is usually a combination of factors.

Mental health can play a role. Rates of mental health issues have increased 65% in the military since 2000, with 936,000 troops diagnosed with at least one mental health issue.


Factors such as insomnia, depression, anxiety, substance use disorders and sexual victimization also to contribute to suicide risk among service members and veterans. Regarding the latter, 55% of women and 38% of men have experienced sexual trauma during their service.

In addition to mental health issues, common experiences that military personnel who die by suicide encounter include strained relationships, financial issues, legal or disciplinary actions and difficulty readjusting following deployment. These situations can be overwhelming, leaving service personnel to think they cannot continue to cope.

For veterans, there are more common factors. Newly discharged veterans who have challenges transitioning back into civilian life or in their relationships are at increased risk. Older veterans who are still struggling with unresolved distress associated with their military service are also more likely to die by suicide.

The most common means of death by suicide for military personnel is firearms. About 70% of military suicides involve firearms as opposed to around 50% of suicides in the U.S. general population. Those currently serving or previously serving in the military are more likely to own guns. Having a loaded firearm at home increases the risk of dying by suicide by 400-600%.


Warning signs

What are the indicators that someone might be contemplating ending their life? Here are some red flags that you want to be aware of:


  • Expressing hopelessness or the belief that things will never get better
  • Talking about wanting to die or wanting to kill themselves
  • Looking for a way to kill themselves, like searching online or buying a gun
  • Behaving recklessly
  • Reporting they have no reason to live
  • Talking about feeling trapped and helpless to make things better
  • Expressing that they feel like a burden to others
  • Withdrawing or isolating themselves
  • Showing rage or talking about seeking revenge
  • Taking care of personal affairs, such as suddenly making a will or giving things away
  • Writing a suicide note
  • Exhibiting agitation, anxiety and/or depression
  • Expressing a sense of being disconnected (“No one would care if I were gone”)


Protective factors

In addition to risk factors, there are protective factors that can help someone decrease their risk of wanting to end their life. These include:

·       Having strong, supportive relationships

·       Engaging in effective problem solving rather than avoiding problems

·       Embracing hope that things will get better

·       Avoiding high risk situations, like having a loaded firearm readily available and abusing alcohol or drugs

·       Having meaningful purpose in their lives

·       Getting counseling and support


What’s happening?

When I work with people who have lost a loved one to suicide, a question often arises, “how could they do this?” It could be related to, “how could they end their life? How could they cause me and their loved ones such devastation? How could they think this was the only answer?”


It is important to understand when someone is having thoughts of killing themselves, more often than not, they are in the psychological Red Zone. The Red Zone happens when we experience distress, or any emotion we don't want, at high levels. Consider distress as existing on a continuum from zero (no distress at all) to 10 out of 10 (the most distressed you've ever been). The Red Zone happens when you are at a seven out of 10 or higher.


In the Red Zone, our brain processes information differently than it does when we are at lower levels of distress, what I call the Green Zone (0, 1, 2 or 3 on the distress scale). In the Green Zone, you use more of your frontal lobe, that structure in your brain that differentiates you from other animals. It allows you to engage in executive functioning, problem solving, and perspective taking. Using the frontal lobe, we can assess what the consequences are, we can see the positive and not positive in potential actions. Here, the thinking might be “times are tough, and I know I can make them better.”


However, as we go up on the distress scale, our rational thinking becomes weaker, and we use our frontal lobe less. And in fact, when you get into the Red Zone (a 7, 8, 9, 10 out of 10 on the distress scale), you are using more of your limbic system. The limbic system is the emotional reasoning center responsible for things like fight-or-flight. In the Red Zone, our brain focuses on what is wrong as opposed to what is right.


Someone who is considering ending their life is usually spending a lot of time high up in the Red Zone. From a Red Zone perspective, it's almost as if they are at the bottom of a very deep well with only a pin prick of light. And for someone who is really in the Red Zone and having strong suicidal ideations, that tiny bit of light is ending their life. As such, most people who are having suicidal thoughts are not thinking rationally. Pervasive hopelessness, or the belief that things will never get better, dominates someone’s thinking who is considering ending their life.



What to do

If you or a loved one is struggling with thoughts about wanting to no longer be here, please seek support immediately.


Asking for support is a sign of strength

A soldier is taught in training to rely on their soldiers during combat. Even for positions that require some independent work, every soldier has a team that supports them. And just like on the battlefield, it is vital that you rely on the support of others to help you thrive.


Call 988

There is a relatively new three-digit dialing code that goes directly to the National Suicide Prevention Lifeline. The number is 988. While not functioning in all areas of the U.S., it is expected to be available throughout the country by July 16th, 2022. The phone number 988 is answered by people who specialize in helping prevent suicide and providing resources for treatment. Call 988 if you or someone you care about is seriously contemplating ending their life.


Lock up unloaded firearms

Research shows that storing weapons unloaded and locked up significantly reduces death by suicide. People who die by suicide are often in the psychological Red Zone. As such, they are not thinking or behaving 100% rationally. By keeping firearms locked up and unloaded, it takes extra steps to be able to use the gun on themselves.


Focus on hope

Hopelessness, or the belief that things will never get better, is the number one predictor of suicide. It is vital that we all remember that even during difficult times, things will get better. Life is full of ups and downs. When you were in a down spot, sometimes it is hard to believe that things will get better. And they will. Hope is a skill that anyone can learn.


Talk to them

If you have concerns that a loved one is considering ending their life, it is vital that you speak to them. There is a common myth that overtly asking about suicide will plant the idea in their head. However, that is not true. In fact, overtly asking someone if they are thinking of hurting themselves is the first step to getting them the help that they need.


Here are some tips on how to support someone who may be contemplating suicide:

·       Stay calm and free of judgment. You want to convey that you are there to help and not judge them.

·       Ask specific questions like, “are you having thoughts about hurting yourself” or “do you wish you were dead?”

·       Listen to what they want to share. Encourage them to express what they are going through.

·       Remove any lethal means, like weapons, drugs, or medications.

·       Do not leave them alone.

·       Encourage them to get help voluntarily. Do not force the person.


Currently the Army has a program called ACE:

A: Ask
C: Care
E: Escort

This process is also good for those outside the Army.

Get the needed support and counseling

There are several initiatives right now to provide research- based interventions to help those in the military and veterans. One such program was created by my mentors, Dr Arthur M. Nezu and Dr. Christine Maguth Nezu. In addition to offering free in-person services to U.S. veterans, National Guard, and reservists in the Philadelphia area, there is also a web-based program called Moving Forward that is free.


Our servicemen and servicewomen deserve support. It is because of them that we have our freedom. If you have a loved one who is active military, a veteran or in the reserves, make sure you are reaching out to them. You could be instrumental in helping to save their life.


Dr. Elizabeth Lombardo is a Licensed Practicing Psychologist with a Ph.D. in Psychology and a Master's degree in Physical Therapy, and the authority on how to crush your inner critic so that you can live a life of purpose, fulfillment and True Success™. She’s America’s most trusted celebrity psychologist with over 100 national media interviews. She writes for Combined Insurance in an effort to help educate readers, but her medical opinions and advice are for entertainment purposes only and should not be considered a substitute for visiting your doctor.