How do we prevent military suicide?

How do we prevent military suicide? The short answer is that we don’t. We can’t prevent every suicide but we can do a lot of prevention work that has the potential to reduce the numbers, and every person we help has the potential to help another. It’s a numbers game. The more of our personnel that are educated in male suicide risk factors, and prevention techniques, the more chance we have of seeing warning signs and proactively offering support. I see this repeatedly when the police I have educated, go on to use the knowledge to help colleagues and suicidal males they’re called to.

In the first piece on this topic, I discussed some of the reasons I believe we’re seeing such an uptake in military suicides and also some of the risk factors to look out for, both in ourselves and our colleagues. In this week’s piece, we’re going to discuss some of the issues around support and how we can harness the power of peer intervention.

Vulnerability (not resilience) is key to suicide prevention

Contrary to popular opinion and training in uniformed services, “resilience” is not the key to ‘good’ operational mental health; vulnerability is. More specifically, validating it. Resilience training has its place but all it really entails is promotion of coping mechanisms. I wrote about this, in depth, when discussing police wellbeing here.

It’s stating the obvious to have mental health training tell us to “drink less (alcohol), eat better and exercise more.” Shaming people for their coping mechanisms doesn’t work and conversely, has the potential to increase such behaviours, especially in men. If we take away the coping mechanisms, without a solid replacement or support, we risk his life. We can’t, for example, encourage our men to have a strong “work/life” balance, if either or both aspects are currently problematic.

This isn’t to be confused with operational vulnerability, where we look for weak spots in our unit’s position for example. We’re talking about emotional vulnerability, recognising our weakened spots in our psychological and emotional armour and doing what we need to to strength them up. I always find it ironic when I see (predominantly) men tell other men to “man up” around their mental health, when some of the strongest (physically and psychologically) men I support are those who are the most emotionally intelligent and vulnerable and make incredible leaders.

What we need to do is create safe spaces and relationships with peers where vulnerability is held and validated, not dismissed and mocked. Suicide, for many men, is a shame-avoidant act and/or an act of control. If we don’t work with their shame (perceived or realised) and validate their vulnerability, we have no hope of preventing their deaths. And I know this works because my work is founded on vulnerability and I’ve yet to lose a man.

Formal and peer support

For the last three years, a lot of my work has focused on the uniformed services, especially police, and I see the same staunch attitude around wellbeing in the military; that it’s “formal” (process driven) initiatives or nothing. There is a lot of support available to our military but much of it is reactive and formal. By that I mean, it’s presenting yourself to sick bay or leader to get your support on record, which is often a labyrinth of people, processes and tick boxes. But, as I discussed in my previous piece, men require far more psychological safety than women, meaning we often have to put in the work in the informal, peer sector to get them to seek and engage with formal support mechanisms. A lot of my work with men goes into answering their questions around mental health, normalising their experiences and feelings and reassuring them to get them comfortable in seeking formal support.

We also have to recognise that formal support often comes with career consequences and it’s disingenuous to suggest otherwise. Many military personnel, for example, have weapons, which are a key part of their identity due to their roles, and if they present to sick bay, there is a real chance they’ll lose that privilege, temporarily or permanently meaning they’re unable to fulfil their role, which can increase their suicide risk, not reduce it.

The reason I say that the military (and wider uniformed services) are “naive” around formal support is because it puts the onus on the individual to self-report and there is still widespread stigma, self-perceived or otherwise. A quarter of those with mental health problems, across serving and veteran personnel cite “stigma” as a factor which might affect their decision to seek help (Sharp, 2015). The leading concerns around stigma of reporting mental health problems relates to unit leadership treating them differently, being seen as weak, and unit members having less confidence in them (Sharp). Being outside of uniformed services is one of the key reasons so many speak so freely with me, because they don’t have to fear career consequences or breach of confidentiality.

Such simplistic mindsets around formal support also fail to take into consideration the trauma that poor colleague and leader behaviour can have on individuals. Uniformed services require strong moral compasses and ethics individually and collectively, and when these high standards of morals are not reciprocated through appropriate support, when needed, it can lead to something known as “sanctuary trauma.” This is considered to be when one seeks and expects a nurturing response from an individual or organisation and receives the opposite.

There is also a sense of naivety that because a man can go on operations, and perhaps kill people in the line of duty, that they will be able to apply that same sense of agency and courage to seek help for their mental health but the latter is often wrapped in shame, making it extremely difficult. I’ve lost count of the amount of grown men, including armed leaders, that I’ve had to call their GP on their behalf to get them an appointment for their mental health, explaining to the GP the issues and concerns because they couldn’t face it.

How do we prevent male military suicide?

For me, strong leadership, encouraging and rewarding help-seeking behaviour is key here. Return on investment for mental health initiatives in the workplace can be anywhere from £5-9 per £1 invested, but in larger organisations, it is team-level leadership which is the significant determinate factor in this return. One study found that decreased unit support predicted increased stigma and barriers to care (Pietrzak, 2009). Given each suicide is said to cost the economy approximately £1.7m, and austerity has crippled our military budget, every penny counts in the fight to reduce our military suicide rate.

Strong leadership also incorporates lived experience leadership, which we’re beginning to see with high-ranking leaders publicly discussing their suicidal thoughts and mental health struggles, such as PTSD, giving others permission to others to seek-help. I do however, feel it’s important to caveat this by saying that the majority of the leaders (throughout all uniformed services) often discuss their mental health publicly once they are in positions of career safety, and not when they are continuing to climb the career ladder. This is certainly a recurring theme from the police chief officers and high ranking military leaders (inc colonels) I’ve spoken with, and asked the question about when they publicly shared their struggles.

Peer support shouldn’t be dismissed as a wooly, “cup of tea and a chat.” In uniformed services, I am often criticised when I discuss peer support, with leaders citing the “legal liability” of it, because they can’t control what is said, but let’s be blunt here. If a man is going to kill himself, he’s going to regardless of what a colleague says or doesn’t say. And services can be just as liable if they know a colleague is struggling but leave him on a waiting list with no interim support. I’m on call 24/7 for my men, unlike many formal initiatives which have finite sessions and opening hours, because mental ill health and suicidal ideations aren’t “9-5” issues.

What I find ironic is that many uniformed services will signpost their people toward organisations such as the Samaritans, and whilst they are a fantastic listening resource, they are just that; a listening resource. They also won’t have basic understanding of military procedures, ranks or acronyms and abbreviations and when a man is in distress, the last thing he wants or needs to do is educate the listener before he can receive support. It’s why having a working knowledge and understanding of uniformed services is so vital.

When I run mental health sessions/workshops they’re informal and engaging. More importantly, I call them “sessions/workshops” and not “training” because I encourage and expect participation. I poke fun at myself and the service I’m working with (including the leaders), crack jokes about mental health and suicide (because the topic is serious enough as it is), I swear like a trucker and call everyone “lovely”, whilst usually wearing something pink or sparkly. Most importantly, I discuss suicide directly, from both a practitioner perspective and also someone who has lived and survived it.

I’m the antithesis of the disciplined uniformed services in about every way but it’s one of the many reasons we’re so successful in helping our men from these sessions. I say “we” because I can’t change or save the lives of the men that I do without the men putting in the time and hard work with me, and each other. This isn’t to say that my form of support and education is better than formalised offerings, but to highlight that there is diversity in need. What works for one won’t work for another, so it’s important we are able to offer a multitude of options.

And, again, we have to recognise some of the myths surrounding military mental health, which also bring biases to initiatives offered. Say “military mental health” for example, and most people will jump to a conversation around post-traumatic stress syndrome (PTSD) allowing many men who don’t fit that label (or want to) not to engage with support. However, many studies are beginning to demonstrate that common psychiatric disorders, such as anxiety and depression, are the majority of what our personnel are seeking support for (Hoge et al, 2002).

It’s also a misnomer that good mental health support or “training” costs exorbitant amounts of money. Yes, it needs funding and continual investment but the life-changing and saving support needed takes something far greater: time, and education.

It’s also myth that men don’t talk about their mental health. They do, but they do it in specific ways to specific people. One study found that men were 300% more likely to speak to a chat bot about their mental health than a human. I find that a lot of my support is given through WhatsApp messages and direct messages on Twitter, especially when building trust before we progress to phone and video calls, and physical meetings. What we need to get better at is educating our leaders and peers on how to actively listen and supportively respond. We need to get them comfortable with having the uncomfortable (but potentially life-saving) conversations.

We have become so focused on digitising our wellbeing offerings for economical benefit and ease (especially in the pandemic), we are ignoring the power of humanity. The impact of physically talking with, and receiving support from, a person, or being able to “read the room”, as I do when I run my mental health sessions, to see who could benefit from some follow up support etc. I’ve lost count the amount of strong men & leaders who have crumbled when I’ve touched them on the arm or hugged them for comfort. It’s a fallacy that even the strongest of men don’t require or want softness, or that it can’t be beneficial for them.

How do we prevent military suicide? By talking about it. Not around it or “awareness” sessions on mental health in general. We talk about substance misuse, extra-marital affairs, eating disorders, childhood trauma, shame, vulnerability, how men get to the precipice of suicide (you get the point) and we do it in a way that doesn’t shame or blame them. Many men won’t have these conversations in a room of rank or with anyone they fear could detrimentally impact their career for their honesty, so we have to work around that or we have failed in our duty of care at the most basic of level. 

The fact that our military mental health awareness and offerings have only increased in recent years, yet we’re still seeing an increase in suicides, suggests that what we’re currently doing isn’t working for many and if we continue in this way, the results will remain catastrophic.