The October 2009 suicide figures show that at least 134 active-duty soldiers have taken their own lives, putting the U.S. Army on a pace to break last year's record. If Reserve and National Guard troops are included, the 2009 total has reached 193.

The total number of soldiers suffering from post traumatic stress disorder, traumatic brain injury, depression or family or relationship problems probably exceeds that number by a thousand-fold, either being unreported or underreported.

A Nov. 7 Washington Post report stated: "More than two years after the nation's political and military leaders pledged to improve mental healthcare, their promises have fallen short at military hospitals around the country, according to mental-health professionals, Army officials, and wounded soldiers and their families. Evidence of an undermanned, overworked healthcare system stretches all the way to the Pentagon, where all of the top health-policy positions remain unfilled, leaving a void on an issue long fraught with inefficiencies and entrenched bureaucracies."

The Armed Forces Television Network is saturated with public service announcements dealing with suicide, depression and other mental-health issues. It can only be considered window dressing as long as the military fails to address effectively the conditions that can lead to suicide.

Despite all the hand-wringing and faux concern by many military leaders, the Army's mental-health program remains largely passive and reactive. If they are indeed listening, this has yet to translate into successful measures to correct a seemingly ever-worsening situation.

During one of my tours in Afghanistan and Iraq, three soldiers committed suicide during a 30-day period. Often when a suicide occurs, the typical response is "nobody knew." That is nonsense. Not only are many military members often aware when fellow soldiers are troubled, but the Army culture fosters behaviors that may create the conditions leading to suicidal ideation or suicide itself.

The culture of the armed forces remains such that psychological or social difficulties continue to be considered weaknesses in the warrior ethic. The military has come far in recognizing PTSD as a legitimate illness, but the system continues to view many mental or social disturbances as potentially career-inhibiting traits. This forces soldiers to repress their anger and despair rather than admit these feelings and seek help. Such a circumstance can lead to depression and suicide.

Soldiers having spousal or family relationship problems or those undergoing investigation for potential disciplinary action are often politely ignored or, in the latter case, actively isolated and ostracized. Left unrecognized and untreated, each can lead to isolation, depression or hopelessness, all of which are preludes to suicidal impulses.

In the military, disciplinary allegations, whether true or not, can precipitate removal from duty and social isolation for long periods of time because of underfunded and overworked military defense attorneys and painfully slow processes. During that time, the court of public opinion views you as guilty until proven innocent. I know of one soldier who committed suicide living under such a cloud of suspicion. There was another accused soldier who expressed suicidal intent but with whom a chaplain did not decide to meet, even when requested.

There is not one of us who do not go through times of difficulty or trouble in life. Our men and women in the armed forces undergo stress often far beyond any of those encountered in civilian careers. They deserve the best care their country can offer.

If Pentagon officials think that television commercials, interactive videos or slide presentations will do the job, they are wrong. Competent healthcare providers, vigilance at the lowest echelons and serious efforts beyond lip service at the highest echelons can go a long way. Effective leadership is needed.

No soldier should get left behind because nobody knew or nobody cared.

(Lawrence Sellin, Ph.D., is a colonel in the U.S. Army Reserve and a veteran of the conflicts in Afghanistan and Iraq.)

(United Press International's "Outside View" commentaries are written by outside contributors who specialize in a variety of important issues. The views expressed do not necessarily reflect those of United Press International. In the interests of creating an open forum, original submissions are invited.)

earlier related report
Lack of health care killed 2,266 US veterans last year: study
Washington (AFP) Nov 11, 2009 - The number of US veterans who died in 2008 because they lacked health insurance was 14 times higher than the US military death toll in Afghanistan that year, according to a new study.

The analysis produced by two Harvard medical researchers estimates that 2,266 US military veterans under the age of 65 died in 2008 because they lacked health coverage and had reduced access to medical care.

That figure is more than 14 times higher than the 155 US troop deaths in Afghanistan in 2008, the study says.

Released as the United States commemorates fallen soldiers on Veterans Day, the study warns that even health care provided by the Veterans Health Administration (VA) leaves many veterans without coverage.

The analysis uses census data to isolate the number of US veterans who lack both private health coverage and care offered by the VA.

"That's a group that's about 1.5 million people," said David Himmelstein, an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program who co-authored the study.

Himmelstein and co-author Stephanie Woolhandler, also a Harvard medical professor, overlaid that figure with another study examining the mortality rate associated with lack of health insurance.

"The uninsured have about a 40 percent higher risk of dying each year than otherwise comparable insured individuals," Himmelstein told AFP.

"Putting that all together you get an estimate of almost 2,300 -- 2,266 veterans who die each year from lack of health insurance."

Only some US veterans have access to medical care through the VA and coverage is apportioned on the basis of eight "priority groups."

"They range from things like people who were prisoners of war, who have coverage for life, or who have battle injuries and therefore have coverage for their injuries for life," said Himmelstein.

Veterans who fall below an income threshold that is determined on a county-by-county basis can qualify for care, but many veterans are "working poor" and fall just above the bracket.

"The priority eight group, the lowest priority, are veterans above the very poor group who have no other reason to be eligible and that group is essentially shut out of the VA," according to Himmelstein.

The study comes as the US Senate weighs health care reform legislation and whether to offer government health insurance.

Himmelstein warns that congressional proposals could still leave veterans uncovered and favors a national health care program similar to those in Britain and Canada.

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