Special Operations Forces Medical Handbook

5-149

Mental Health: Suicide Prevention

MAJ Michael Doyle, MC, USA

Introduction: Suicide is the third leading cause of death in the U.S. Armed Forces. Suicidal service members
present a challenge to command and medical personnel. Suicide attempts and completed suicides are very
disruptive to units that experience them. Many suicides can be prevented through awareness of warning signs
and early intervention. The vast majority of Military suicides are committed by 17-25 year old white
males, E-1 to E-4, with relationship problems. Suicide may be attempted by healthy personnel with an
abnormal reaction to operational or relationship stress, or by someone with a mental disorder.

Subjective: Symptoms
Overly stressed, sad, anxious, frustrated, worthless, hopeless, helpless, or guilty; thoughts of self-harm, harm
to others, death or being better off dead; relationship problems.
Focused History: Have you had thoughts of hurting yourself or anyone else? Are you having thoughts now?
Have you ever attempted suicide in the past or have you ever intentionally injured yourself? Have you been
using alcohol or drugs? Do you have access to a gun? How is your relationship with your wife/girlfriend/
husband/boyfriend/significant other? Have you been giving away personal effects? (ask peers or supervisors
if they have observed this).

Objective: Signs
Using Basic Tools: Increasing agitation, interpersonal conflicts, anger, frustration, irritability; change in mood
to sadness, new appearance of depression, social isolation and withdrawal; giving away personal effects;
increased impulsivity or a history of impulsive or violent behaviors.

Assessment:
Differential Diagnosis: Presence of a mental disorder or personality disorder, self-mutilation and self-
injurious behavior.

Plan:
Treatment - Suicidal Ideation and Attempted Suicide

1. Secure the individual’s weapons and ammo. Protect patient and others, including health care staff.


2. Monitor/accompany the suicidal individual at all times.


3. Treat injuries or medical conditions.


4. If imminently dangerous to self or others, hospitalize or place under 24-hour watch. Otherwise, manage
   with a “buddy watch” until the crisis has settled.


5. Identify the stressor that has precipitated this event. A chaplain can often be very helpful in settling
   down home-front crises.


6. Involve the chain-of-command in disposition plans.


7. If discharging a service member to his unit’s custody, always have the service member contract verbally
   or in writing to return immediately if the thoughts of harm recur.


8. After a serious attempt or completed suicide, ask a chaplain or mental health professional to meet with
   the patient’s ship, squad or section mates to address feelings of guilt, remorse or anger. Do not forget
   the medical personnel involved.


9. Remain vigilant for suicide clusters in units known for low morale, frequent or high rates of AWOL/UA,
   poor leadership or other discipline problems.
   Prevention: Closely follow service members who report suicidal ideation, even if ideation is not accompa-
   nied by intent. Let the service member know that you care and can help. Enlist the support of the chain
   of command.