Words matter and an Army challenge

A couple of weeks ago I brought up a concern I had at work.  I've had a good handful of soldiers come into my office for behavioral health intakes and some for individual therapy.  I've heard similar reports from some of the soldiers of how there are a lot of jokes about suicide.  A week ago, I'm not sure what was different, but after meeting with a soldier and hearing their frustrations about this I brought up my concerns to our team.

I inquired if other providers have heard similar stories and threw out some ideas to begin to change the dialogue.  One person, and I've heard this from others, seem to feel it was an uphill battle stating "it's the culture" and then made a comment about the Air Force not have issues like this.  I snapped that the AF has their stuff just like other branches but stating that "it's the culture" doesn't mean we cannot try to raise awareness and start some change.

Things that I have heard from my soldiers is they will sit around and joke about suicide to the point of having conversations on how they will do it.  A soldier reached out not knowing what they should of done when a friend posted suicidal thoughts on social media.  This person was met with jokes, comments of "if they don't do it they are a pussy" and "they just want attention".  I imagined young soldiers having this conversation but NCOs were a part of it!  The ones that are charged with the responsibility of mentoring and leading!  My blood boiled at this.

Having been in the medical field close to my whole working life I am well versed in off color jokes and making serious situations light by jokes and sarcasm.  But suicide have been off the table for me, it's never been a joke.

When I brought this up to our team, another provider spoke up and stated that she's done training with one of her sections.  She has a training/outline for this already and she reported that she got great feedback when she did this.  She did a few separate pow wows, having a different presentation/training/talk with senior leadership, the mid level leaders, and the lowest rung of soldiers and each presentation was adapted to that group!  It was more of a dialogue and as she stated she wanted to educate them on how WE think as mental health professionals.  Why hasn't this been expanding outside of her units?!  
I don't know but one hold up that is coming to light are commanders that are not seeing mental health as a priority of their soldiers.  THAT is the big fight.

I am learning more and more about how the Army works, it's not making any sense to me but with more understanding it allows me to work differently.  For example in the AF when you say commander you are usually talking about a Maj or LtCol, or higher.  These individuals have a decent amount of time in service, some age on them, and should have a broader perspective on things...don't get me wrong I've been exposed to my share of incompetent AF commanders.  In the Army a commander is usually a CPT and I recently met with one in my office.  

Up until this week, in my mind, I kept thinking Army commander = AF commander.  A switch went off this week.  I had this AR CPT who just ended their command, AT 26 YEARS OLD!  Educated with a degree (most often that does not have classes on leadership or management of people) and a crash course in Army life/training. These young adults are in charge of other young adults to the point of ruining one's career, kicking them out, all levels of discipline!  So when when get a new commander and then one of their soldiers are suicidal, have to go inpatient, these young adults are either freaked out trying to figure out what they can do to help or they totally separate from the issue.  As I recently heard from a commander, "if they can't soldier they are useless to me".  

My mind shift went from Oh shit I have to call the commander to I have to call this commander and mentor him/her on how best to help this soldier.  I recently had a commander ask me "what do you think I should do" in regards to letting a soldier go on leave "even though he's failed a PT test".  I acknowledged his situation of having to think of the group as a whole, if he lets one person go under disciplinary action how that would reflect on others unable to go, but I also mentioned to take this soldier's whole story into account.... how has his performance been up until this failed PT test? is this a regular thing for him?  if he's been a stellar soldier up until this incident I, as a mental health profession, recommended he be allowed to go home for the holidays for his mental health.  This information was acknowledged and the soldier was able to go home!

I am older than these commanders by 20 years at time, more time in the military, and then life experience!  What a mind screw that is?!  Apparently I'm a professional and I may even be considered an adult.  When did this happen because I don't feel it at all?!  But with this "ah ha" moment.... I now have a different perspective on how to interact with Army commanders to where I can do the best that I can to help both the commander and the solider.

And one of my task to to help change how people talk about suicide.  I know I work with the soldiers that are pretty rough around the edges with their jobs and being airborne but that does not mean they are unable to change!  I may not make a huge change but if I can get a few people to thinking about things differently and hopefully start using their voice to start a ripple of change.  Anything is possible.

A recent loss

"It's not if but when" that is what we heard during my MSW program in regards to a client who will commit suicide.  It's a sad thought but that is the business we are in.  That phrase comes to mind if not daily, weekly, as I work with soldiers who are struggling.  I've been thinking about suicide a lot lately, and I'll explain why in a minute, and today I realized even more that the odds are stacked against me in when someone I know, work with, or treat will be affected by suicide.  Not only am I working with depressed individuals but I also have chosen to work with military, active duty and veterans.  In addition to that, I am a veteran, so a majority of my friends, family, and acquaintances are military.  We all hear the news on what military/veteran suicides look like.
On a daily basis, I have to assess the risk of a client walking away and harming him/herself.  Working on the inpatient unit in Florida that risk was there but there were more ways to mitigate the risk.  Working at the VA and now on the Army base, my ability to mitigate the risk is extremely limited.

At the VA I worked with a young veteran that had severe PTSD, TBI, and medical problems which in itself is a struggle.  He also had a troublesome relationship resulting in a toxic cycle of doing well and then making an attempt on his life.  This cycle would last a month, so on average, every month (if we were lucky 2 months) this veteran attempted to take his life.  During my work with him I did therapy but also tried to get him into an inpatient facility, private and VA.  I got excuses and refusals!  He's not stable, medically or mentally, I would be told OR there would be a month or more long wait to be admitted.  This service member did not have that luxury.  The veteran had a serious attempt, and was put in the state psychiatric hospital.  Those stays are short with no real treatment, think padded room environment and medications.  Once notified of this I went to my supervisor so frustrated at the system and scared for this veteran that I was in tears.  My supervisor calmly looked at me and tried to comfort me, thinking I was upset that I did something wrong and it was my fault that he was admitted.  I quickly informed him my tears were not of sadness but that I was so pissed and frustrated that I've been trying for months, talking to him and others at work, for help and guidance on how to get this veteran admitted into a facility that would help him.  He seemed a little surprised but getting "emotional" got more people involved and I was able to find a private facility that would take him in.  This is one of many reasons I decided to leave the VA and find employment elsewhere.  Before I left the VA, he was still in inpatient and doing well.  I pray that he is still doing well.

At my current job I have seen a soldier for numerous weekly sessions, after they had worked with a different provider for a handful of sessions.   This service member has daily suicidal thoughts and with treatment, has not improved but has remained stable.  We had a conversation what stable meant, they thought it meant "doing well" I informed them that stable is no change so things can by shitty but be managed, "stable shitty".  I'm not going to go into details but the bottom line is that the Army is not a good fit for this individual.  Which is a part of my job.  I have two bosses when I'm meeting with a soldier, helping the soldier but also ensuring that the Army has a fit and ready soldier to accomplish the mission.  So it would be best for the service member's mental health to be discharged and that is in the works but it takes time.  
So here we are in the holiday season.  I meet with this person weekly and there is not enough spider senses going on and what is reported from the individual to push for an inpatient stay...this individual has already had one due to intense suicidal thoughts with intent.  After every weekend I call the inpatient unit and ask if any of our soldiers were admitted and every time I ask I hold my breath hoping it is not my soldier or any other soldier for that matter.

So, if this my normal life now as a social worker why the uptick in thinking about suicide?

I woke up the other morning and saw a post from a friend's wife that my friend, Jake, is no longer alive.  I was shocked.  I didn't know why.  There was no indication in the post.  I thought maybe he was ill and nothing was mentioned?  I worked with Jake while being a part of the reserve unit in Utah.  It's been years since we've actually interacted but we are Facebook friends so I've seen his family grow, promotions in the military, family vacations.... a happy active family doing their thing.  So I was confused.  At work I tried the google thing to see if anything would pop up, nothing.  A lot of people sharing condolences on FB but still no why.  I text a friend in the area and although she has lost touch with him also, from another friend it sounded like Jake died by suicide.  
I'm at work... my feelings of shock, concern, questioning turned back into shock and now despair at this news.  Again the questions? Why?  Tears came to my eyes, I lost my appetite, and I was at a loss.  
I'm at work and got soldiers to see, so like any military member, I tap into my military bearing and get back to work. In between appointments I talked to my supervisor about it and we touched base at the end of the day again but I find myself at a complete loss.  Then I came home and processed it some more with Joe.

This morning I woke up and looked at Jake's FB page and looked at his pictures. These are the same pictures that I noticed in the past while I scrolled through FB. Pictures of a happy family full of smiles and good times.  Then I really started to look, at the body language and the eyes...was there pain and sadness? or am I seeing something now that he is gone and I'm trying to rationalize why he would take his own life?  When it comes to death, we will never have an answer although our brain wants so badly to make sense of something that will never make sense, even if we had reason for it.

Most people don't post their pain and personal struggles on social media so how many of us scroll through pictures not really seeing them and just blindly hit "like" or "love"?  HOW MANY TIMES DO WE DO THIS IN REAL LIFE?!  We ask how someone is doing, we exchange pleasantries, but we DO NOT REALLY SEE OR LISTEN to that person.  
As a society we have become "ten second Tom's" in that things need to be quick.  We size up situations, we make hasty responses, we move on to the next thing, the next person, the next interaction.  

PLEASE slow down in your life.  Be present with the person you are with and truly engage with your life and with people.  Take the time to listen and follow your gut instinct that cries out that someone is not fine, when they say they are with a smile and a joke.  There is too much negativity in our world so we need to actually be there for one another, showing kindness, being vulnerable with each other in our pain and in our joy.  Not only do we need to be open to others but we need to be open TO others when we are in pain and need help.  How many of us go through life with a mask on, not being genuine with others... hoping that no one notices our own pain and struggles but wishing someone would care?

I only worked with Jake a few years, if that, before moving away but the world lost a gentle soul.  Jake was always there with a smile, he was dependable, smart, and so very caring and non-judgmental of others.  I hope that he now feels what everyone else saw in him, wherever he may be.  


National Suicide Prevention Lifeline:
1-800-273-8255.... press 1 if you're military