Suicide among Veterans

Why is suicide risk higher in trauma survivors?  It may be because of the symptoms of PTSD or it may be due to other mental health problems. People with PTSD suffer from a range of symptoms that interfere with their capacities to enjoy normal life.  Military veterans who attempt suicide are not only at high risk of another suicide attempt, but have an overall heightened risk of death from all causes.  Also three times more likely to die from any cause than people in the general population.

Britain faces a "ticking timebomb" of mental illness and suicide among young Army veterans who return from hand-to-hand combat in Afghanistan, A lack of mental health care for veterans, combined with the stress of fighting the Taliban, will mean many survivors of the conflict pay a heavy price in psychological problems and self harm. Veterans aged 18 to 23 are up to three times more likely to commit suicide than their civilian counterparts. An estimated 264 Falklands veterans have committed suicide since the conflict ended, compared with 255 soldiers killed in action, according to an ex-servicemen's organisation. Twenty-four British soldiers died during the 1991 Gulf War, but the Ministry of Defence disclosed that 169 veterans of the conflict had died from "intentional self-harm" or in circumstances that led to open verdicts at inquests. The intensity of current operations in Afghanistan we are building up a timebomb of mental health problems.

 Many suffered in silence – often harbouring suicidal thoughts – because they were reluctant to admit to their vulnerability. Servicemen and women are exposed to stresses that most people won't be exposed to in their lives. In Afghanistan, they are exposed to them quite early in their careers. Ex-servicemen under 24 were between two and three times more likely to kill themselves than men of the same age from outside the forces. They are already more vulnerable to suicide before joining up; that they had trouble re-adapting to civilian life; or that they were affected by "exposure to adverse experience. Young men leaving the armed forces appear to be at a higher risk. That needs to be recognised. We have made great progress both in the treatment of mental health problems and in reducing the stigma associated with seeking help. Resettlement packages for veterans returning to civilian life should be based on need, not just length of service. The full resettlement package for former forces personnel is only available after four years service.

Veterans’ mental health is also a priority for the Improving Access to Psychological Services (IAPT) programme. However, many areas still lack appropriate, accessible services for veterans. The mental health problems most frequently suffered by veterans are common mental health problems such depression and anxiety, and substance abuse problems, rather than PTSD.  Research suggests that common mental health problems affect about 1 in 4 service personnel and veterans, alcohol abuse about 1 in 5 and PTSD 1 in 20. While most veterans do not develop mental health problems as a result of serving, those that leave the forces with a mental health problem often do badly and many do not receive help.

The PTSD literature for veterans lists conditions that are commonly found among survivors of those types of trauma. Survivors typically have only some of these symptoms, and the severity of a particular symptom may vary from individual to individual. Survivors of different types of traumatic events often have a different range of symptoms. A remarkably large number of these conditions are common among people with long-term histories of suicidal pain:

• Problems with memory. Persistent, intrusive, and vivid memories concerning the traumatic situation.
• Events of daily life may trigger distressing memories related to the trauma.
• Memory lapses for parts of the traumatic situation.
• Many suicidal people are troubled by strong images, such as the feeling that they have bombs inside their bodies or a knife over their heads.
• In recovery continue to be bothered by the memory of having had these images.
• Avoidance of things associated with the traumatic experience.
• Denial on the seriousness of the experience.
• Persistent anxiety.
• Fear that the traumatic situation will recur.
• The trauma is often an event that shatters the survivor’s sense of invulnerability to harm.
• Disturbed by the intrusiveness of violent impulses and thoughts.
• A feeling of being powerless over the traumatic event. Anger and frustration over being powerless.
• A feeling of being helpless about ones current condition.
• Being dramatically and permanently changed by the experience.
• A sense of unfairness. Why did this happen to me?
• Holding one-self responsible for what happened. Feeling guilty.
• Being dramatically and permanently changed by the experience.
• A sense of unfairness. Why did this happen to me?
• Holding one-self responsible for what happened. Feeling guilty.
• An inability to experience the joys of life.
• When people with PTSD try to return to normal life, they are plagued by readjustment problems in the basic elements of life.
• They have difficulties in relationships, in employment, and in having families.
• A lack of caring attachments. A sense of a lack of purpose and meaning.
• Some chronically traumatized people lose the sense that they have a self at all.
• Veterans report the feeling that they never really made it back from the war. Formerly suicidal people feel they never really made it back to normal life.
• In personal relationships there are problems of dependency and trust.
• A fear of being abandoned, betrayed, let down.
• Feelings of self-hatred and humiliation for being needy, weak, and vulnerable.
• Alternating between isolation and anxious clinging.
• No sense of having a future or, the belief that one’s future will be very limited.
• Loss of self-confidence and loss of feelings of mastery and competence.
• A resistance to efforts to change a maladaptive world view that result from the trauma.
• The severity of PTSD symptoms tends to increase with the severity and duration of the trauma.
• The use of alcohol or drugs to cope with the PTSD symptoms.

Survivors of traumatic experiences are often told, it’s in the past. Forget about it and get on with your life, snap out of it. Why can’t you just forget about all that, and enjoy life like a normal person? If it was that simply get on with life, they would have done it. PTSD helps explain why it is so hard for the chronically suicidal to recover.  In a support group we have a chance to talk about our suicidal histories without the fear that we will be taken to a hospital for doing so. We can talk about the isolation, the fears, the pain, the confusion, the acts of self-injury, the behaviour of others that was stigmatizing, denying, abusive, the horrible sense of estrangement that exists when you are in a terrible situation and there is no one who understands what you are going through, the hatred and contempt for oneself and the world, the debilitating sense of personal weakness. We see that we are not alone. We do not have the seriousness of our condition minimized

  Veterans have cited the lack of understanding of their forces background from civilian services as a key barrier to both seeking and receiving support. There is a strong case for veterans to be involved in the training of health professionals who come into regular contact with veterans. While the mental health of serving personnel is provided by the Defence Medical Services, veterans are not entitled to this support, and receive treatment through the NHS.  More needs to be done to ensure that veterans themselves do not see mental health problems as a sign of weakness.  Veterans could be the target of local health promotion initiatives and the case is strong for veterans to be involved