The typical nature of Army instruction fails to properly address how to handle suicidal soldiers. Serving as a volunteer instructor at the Combat Medic (68W) sustainment course allowed me to develop an approach tackling the difficult subject of suicide in the military. This approach comes for my experiences working as the Deputy State Surgeon of the Nebraska Army National Guard and my experiences working directly with homeless and disabled veterans with the Nebraska Department of Labor. Effectively addressing suicide requires an understanding of the negative impacts of cognitive dissonance, the impact of disease/injury on suicidality, and the resources to assist suicidal soldiers.
The views in this post are of the author and do not reflect official policy of the United States Army or the U.S. Government. They are tips to leaders in understanding and assisting soldiers with suicidal ideations. They are not a replacement for medical or professional attention.
Franklin C. Annis holds a Doctorate in Education (EdD) from Northcentral University. He is a veteran of Operation Iraqi Freedom having served as the 2nd Platoon Leader of the 313th Medical Company (Ground Ambulance) during OIF 9-11. Franklin is currently assigned as the Deputy State Surgeon for the Nebraska Army National Guard. He also created the YouTube channel ‘Evolving Warfighter’ that presents materials on how to improve leadership through Self-Development.
Avoid Cliché
Suicide is a complex and difficult topic. Unfortunately, due to the nature of military instruction, we tend to overly simplify our approaches to suicidal thoughts and repeat the Army suicide awareness mottos or slogans ad nausea. You can only hear, “Suicide is a permanent solution to a temporary problem” so many times before it loses value. When overused, this phrase removes any perception of genuine concern. Suicide is a complex and difficult topic to address. We shouldn’t strip away the most important message, which is that we care about our soldiers.
A Cry for Freedom
Soldiers with suicidal ideations too often perceive an inability to change their circumstances and lack hope for a change in the future. Leaders can help these individuals by finding them resources and reducing their feeling of powerlessness. Show them that change for the better is possible, even if it comes in the smallest increments. A soldier saying, “I want to kill myself” is really crying out for freedom.
Don’t Wait to be Trained on Suicide Intervention
Suicidal ideations are common. Trauma and tragedies occurring to soldiers are 
more a question of “when” than “if” they will occur. The annual suicide awareness brief is inadequate to prepare leaders for the task of suicide intervention. Luckily, the Army offers a two-day civilian suicide intervention course called Applied Suicide Intervention Skills Training (ASIST). All leaders should attend this course. If you have medical personnel within your unit, send them to this training as well.
Cognitive Dissonance
Cognitive dissonance, or the simultaneous belief in two contradicting ideas, can be extremely damaging to the human mind. It can be a source of tremendous emotional and cognitive distress, until the dissonance (disagreement) is resolved. In this process, an individual must select which one of the beliefs is most “true” and abandon the other belief. The individual’s level of support and investment in each of the conflicting beliefs creates difficulty and can lead to thoughts of suicide. This is due to an inability to resolve conflict. We must be honest with our soldiers and inform them of the conflicting values built into their military programing to ensure their survival on the battlefield. These conflicting values may create extensive cognitive dissonances upon redeployment.
Moral Injury
A moral injury occurs when an individual violates a core value on which they built their personal identity. The results of a moral injury manifest in symptoms similar to Post Traumatic Stress. An example of a moral injury might be a soldier coming to terms with their accidental involvement in an event that killed a civilian on the battlefield. It becomes a violation of their own moral standards to a point where they no long understand who they are as an individual. In his book, Achilles in Vietnam, Dr. Jonathan Shay demonstrates how moral injury can be such a destructive force by using the example of Achilles in the Trojan War. This book is worth the read for leaders seeking further understanding of the topic.
Medical Causes for Suicidal Ideation
Reshaping thoughts and perspectives is a large part of recovering from suicidal ideations. However, changing an individual’s cognition may not be possible due to underlying medical situations. Medical conditions such as traumatic brain injury (TBI), chronic pain, and drug/alcohol dependence must be addressed by medical professionals if suicide intervention is to be effective.
Normalize Seeking Help
Our National Guard Soldiers often face the struggles of redeployment alone, geographically separated from their fellow squad-members. When I personally faced these struggles, I resisted getting professional help. It was the raw honesty of our Sergeant Major that convinced me to seek help. Standing before the battalion, he spoke openly about his own struggles. At the time I did not know the term “post-traumatic growth”. His story of becoming a better soldier after seeking behavioral health, made a profound impact on me. His honesty destroyed the illusion that I would be thought of as less of a leader if I needed help. Leaders who have personal experiences with these struggles can make a huge difference. Your stories about how one can grow stronger and overcome could save a life.
Resources for Suicidal Soldiers
Look for resources in your community to address various concerns within your soldiers’ lives. Be proactive and do so before you find yourself needing to help them deal with a crisis. Useful resources include the Veteran Crisis Line, Vet Center, GiveAnHour.Org, Disabled Veteran Outreach Program (DVOP), State Department of Labor, Military One Source, Chaplain Corps/Civilian Clergy, and 911.
Caring
The effectiveness of preventing suicide within your ranks begins long before a crisis. It begins by establishing a genuine environment of caring for your team. It will take a considerable amount of courage from your soldiers to ask for help with suicidal ideations. Ultimately, that soldier gets the final say. But, your daily interactions and care can make all the difference. You are in a better position to intervene when you are a positive force and actively involved. You will be in a better position to notice changes in behavior or significant negative events in your soldiers’ lives. Take these times to ensure your soldiers have access to the resources they need. Intervene early to ensure they know people care and there is help.
No Positive Feedback Loop
There is rarely a positive feedback loop for helping suicidal soldiers. Soldiers rarely return from command directed behavioral assessments and outwardly show thanks. This may even be the case when your intervention resulted in lifesaving aid. But, if you are questioning whether you should intervene, take it as an indication that you should take action. When in doubt, let your soldiers be upset that you care too much. It is a significantly better option than not valuing their lives enough.
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Due to the nature of moral conflicts found within warfare, suicidal ideations will continue to be a struggle. But, it is our duty as military leaders to understand the causes of suicidal ideations and prepare ourselves to intercede. We need to continually research and expand our understanding of suicide. Honesty and care are keys to getting our soldiers the behavioral health care they need. Together, we can find ways to celebrate the post-traumatic growth that can develop our soldiers into better warfighters and citizens.
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Check out Dr. Annis’ YouTube Channel – The Evolving Warfighter – for more resources. Below is Part I in his series “A Leader’s Guide to Addressing Suicide”.