Military Suicide: Help for Families Worried About Their Service Member

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In this week’s TIME cover story, “One a Day” (available to subscribers here), journalists Mark Thompson and Nancy Gibbs explore why suicides among the U.S. military have reached crisis levels. Every day, one active-duty service member dies by his own hand, the authors note: “The U.S. military seldom meets an enemy it cannot target, cannot crush, cannot put a fence around or drive a tank across. But it has not been ale to defeat or contain the epidemic of suicides among its troops.”

The specific triggers for suicide are unique to each soldier. Each person deals differently with the stresses of war, frequent deployments, separation from family, death of comrades. Many contend with depression and post-traumatic stress upon returning home. There are several programs and support lines for these soldiers, but it also helps for their immediate families to remain vigilant and to monitor their behavior. Even still, many service members fall through the cracks.

Below is what we hope is helpful advice for military spouses, who want to know what warning signs to look for in their service member and how best to handle severe situations. One immediate sign, say experts, is a pervasive sense of uselessness, a feeling that they no longer belong. “What we learn from our families [who lost service family members to suicide] and what they saw in their loved ones, is behavior [in which they] pulled back and felt they were not able to be a useful part of unit that relied on them,” says Bonnie Carroll, founder and chairman of the Tragedy Assistance Program for Survivors, or TAPS, a non-profit that supports those who have lost a loved one in the military. “These men and women need to know they are still a part of a unit at home and overseas.”

(MORE: Military Suicides: The Stigma of Seeking Help)

Here, experts offer more answers to common questions that military families face when a loved one shows signs of trouble:

What are the signs of suicide risk to look out for?
There are many signs of suicide, says Kim Ruocco, director of the suicide prevention programs at TAPS. Some key warning signs to look out for:

  • Hopelessness and saying things like “This will never get better”
  • Helplessness and saying things like “I can’t do anything about this”
  • No longer finding joy in things they once enjoyed
  • Angry outbursts and increased agitation
  • Sleeplessness or oversleeping
  • Lack of appetite or increased appetite
  • Withdrawal from friends and family, or suggestions that family would be better off without them
  • History of suicide attempt and history of depression
  • Post-traumatic injury

Warning signs of suicide that call for immediate attention:

  • Talking about or making plans to take his or her own life
  • Putting personal affairs in order
  • Giving away personal possessions
  • Obsessing about death
  • Abusing drugs or alcohol
  • Acquiring or obtaining access to lethal means (prescription drugs, weapons, etc.)
  • Engaging in out-of-the-ordinary or risky behaviors

“You should always ask someone if they are thinking of killing themselves and if they are, do not leave them alone, escort them to help, take them to a doctor at primary care, behavioral health or the emergency room,” says Ruocco. “Sometimes a person will deny thinking of suicide despite warning signs. These people should also be considered high risk and be taken for immediate evaluation.”

(MORE: Captains Courageous)

Whom should I contact if I’m concerned about my loved one? 
The first person to speak with is your loved one. Ask your he or she is feeling, says Eileen M. Lainez, a spokeswoman for the U.S. Department of Defense. For example: Do you feel as if you could harm yourself? How often are you having those kinds of thoughts? Do you have a plan to harm yourself?

“Keep track of all conversations with a service member who expresses any indication that he or she could harm him or herself, or is experiencing unique or intense stressors,” says Lainez.

There are several 24/7 service lines open to family members who have immediate concerns:

  • Military Crisis Line: Dial 800-273-8255 (press 1 for military) or visit the crisis line online, which provides a chat and text service for veterans (see below) and active duty members
  • Veterans Crisis Line: Visit Veterans Live Chat or call 800-273-TALK to talk with a crisis counselor
  • DCoE Outreach Center: Visit Real Warriors Live Chat or call 866-966-1020 to talk with a health resource consultant
  • Military OneSource: Call 800-342-9647 for one-on-one counseling or visit online
  • Do not hesitate to call 911 in an emergency

Should I alert the military if my loved one is showing signs of suicide at home?
Anyone concerned about a service member for any reason should not hesitate to contact that service member’s supervisor, commander, any health-care provider or a chaplain. “If the family member is looking for behavioral health support, information or resources, they should contact [these individuals]. The earlier an adjustment or behavioral health issue is identified and addressed, the more likely a positive outcome will result,” says Lainez.

Is there anything I shouldn’t do?
Don’t be afraid to be proactive: Ask your loved one questions about suicidal thoughts or plans, and do not hesitate to get help. “Suicidal thoughts can be a medical emergency. Someone who has been thinking about suicide over time can lose the ability to control the impulse. Put aside fears of betraying your loved one or ruining his [or her] career and chose to save his [or her] life,” says Ruocco.

(VIDEO: How Dogs Help Veterans Cope With PTSD)

Should I be more concerned if my loved one has been overseas for several tours, or less concerned if he or she hasn’t?
There are many factors associated with suicide, which make it difficult to point to any one factor as a root cause. Currently, there is no evidence directly linking the number of deployments to an increased risk of suicide. Any warning signs of suicide should be taken seriously, regardless of the number of times the service member has been deployed overseas.

“Combat exposure can increase risk for suicide, especially if the service member was exposed to trauma or suffered a concussive injury,” says Ruocco. “However, about half of our service members who die by suicide have never deployed, so the fact that they have not deployed should not be a reason to not seek treatment.” The 2010 Department of Defense Suicide Event Report found that indeed half of all service members who died by suicide during 2010 had never been deployed to Iraq or Afghanistan.

What can I do to support my soldier and help prevent suicide risk?
Real Warriors, a campaign started by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to promote recovery and resilience among returning service members, suggests that you encourage and help your loved one do the following:

  • Cut back on obligations when possible and set reasonable schedules for goals
  • Consider keeping a journal to express pain, anger, fear or other emotions
  • Avoid isolation — get together with buddies, commanding officers, family, friends or other members of the community regularly
  • Stay physically fit by eating healthy foods and getting enough sleep
  • Stay motivated by keeping personal and career goals in mind
  • Use relaxation techniques to help manage stress
  • Stay organized by keeping a daily schedule of tasks and activities

(PHOTOS: Suicide in the Recruiters’ Ranks)

There are plenty of mental-health resources out there, but here are a few we highly recommended for service members and their families:

Read the full TIME cover story, available to subscribers here.