They return from war traumatized.
They have survived the grinding stress of being in constant danger. They have seen the worst. Some have injuries that will never heal.
To stay alive, they have learned to trust no one and to never show weakness.
It’s something they don’t want to talk about.
And it’s killing them.
Veterans commit suicide at a rate that is twice the national average. In fact, the annual military death toll from suicides has for several years exceeded the number killed on the battlefields of Iraq and Afghanistan.
For some returning vets, their injuries are obvious. Many others struggle with unseen wounds like post-traumatic stress disorder and traumatic brain injuries.
But, it’s not just combat vets. In 2010, at least 54 percent of U.S. military suicides had no history of deployment and 89 percent had no combat experience, according to the U.S. Department of Defense’s one-year-old Suicide Prevention Office.
Even for healthy veterans, returning home isn’t always a relief. Many miss the structure of military life and the companionship of their comrades. They find themselves competing for jobs with younger workers who have more up-to-date training. And some return to relationships that have withered or even broken in their absence.
It can all be too much.
In Montana, where nearly 10 percent of the population has served in the military, at least 460 veterans committed suicide between 2002 and 2011, according to the Montana Department of Public Health and Human Services.
“We go to war to protect ourselves and to give our kids, our grandkids and ourselves the lifestyle we have every day,” said Kellie Lafave, an RN and suicide prevention coordinator for VA Montana since 2005. “Sometimes we don’t want to think about the consequences of what we ask people to do in order to make that happen.”
The rate of suicides among veterans in Montana reflects the state’s high rate.
During 2010, at least 227 Montanans killed themselves. Another 225 people killed themselves in 2011. That’s about 22 people per 100,000 residents, nearly twice the national average.
Not only has Montana's suicide rate hovered in the top five nationally for decades, it has lately increased. The nation is also experiencing a spike in suicides.
“There are a lot more suicides than we ever wanted to know about,” said Lafave. “I think it’s always been like that, but we didn’t have the numbers. When you give people numbers it makes people sit up and take notice.”
Along with everything else veterans have to deal with, their troubles are compounded by the same factors that push up the suicide rate for all Montanans: a shortage of mental health professionals and facilities; a high rate of alcoholism; a cowboy culture where seeking treatment may be seen as weakness; and the prevalence of firearms.
Guns are the most common means of committing suicide in Montana, which ranks third in the nation for per capita gun possession.
In 2010, the most recent year statistics are available, 62 percent of U.S. military suicides involved firearms, and 48 percent of the guns used were personal weapons, not military-issued. The Pentagon recently distributed 70,000 free gun locks to the military services in an attempt to stop the death toll.
The government has also increased the number of programs and services designed to help veterans cope. Yet almost 40 percent of veterans don’t take advantage of any kind of military medical service.
That’s partly because of a military culture that can view seeking help as failure.
“It could be the end of their career if they say, ‘Oh, I just can’t do this today,’ or if they say, ‘I just can’t face it one more time,’ ” said Lafave, the VA nurse.
They also fear that seeking help for mental health issues will get them discharged or passed over for promotion.
A national average of 18 veteran suicides a day is too high, said Jan Kemp, director of the U.S. Department of Veterans Affairs’ Mental Health Program for Suicide Prevention. If there’s any good news it’s that the number has stabilized over the past few years and might be down slightly since the beginning of Operation Iraqi Freedom and Operation Enduring Freedom. A report is due at year’s end.
“Veterans are still at greater risk than the general population,” Kemp said. “We have to continue to work on that.”
There are two groups of veterans that concern her because their rates of suicide are higher than others: young adults in their early to mid-20s and those from the Vietnam era.
“That relates back to all sorts of issues like retirement, loss, physical pain, medical problems and on top of that, they may have some unresolved PTSD issues that are manifesting themselves now.”
The VA has been taking a proactive approach toward military-related suicides since the passage of the Joshua Omvig Veterans Suicide Prevention Act in 2007. Omvig was a 22-year-old veteran Army specialist from Gillette, Wyo., who served an 11-month tour of duty in northern Iraq with the 339th Military Police Company.
Omvig returned from Iraq in 2005, less than a week before Thanksgiving and quickly began to exhibit signs of depression, suffering from flashbacks and nightmares. He never sought professional counseling because he worried that doing so would damage his career. In December 2005, Omvig sat in his truck in his parents’ driveway and shot himself.
Five years ago, the VA dedicated resources, programs, services, crisis numbers and chat lines to suicide prevention. The goal was to save one veteran at a time and reduce the stigma associated with mental illness.
“We’re really trying to teach these folks that it’s just another act of courage to get help,” Kemp said.
The apparent stabilization of veteran suicides is different from what’s happening in the military, however, Kemp said, and is cause for concern.
A 2011 report from the Center for a New American Security found that, nationally from 2005 to 2010, a service member took his or her life about every 36 hours.
For 2012, the Pentagon has reported a record number – 320 suicides, or nearly one a day. That’s double the number of military suicides in 2001, before more than a decade of war.
No one, no matter the rank, is immune. One of the latest high-profile suicides occurred less than two weeks ago.
U.S. military officials are investigating the apparent suicide of a Navy SEAL commander in Afghanistan. Cmdr. Job W. Price, 42, of Pottstown, Pa., died of a gunshot wound to the head Dec. 22 while supporting stability operations in Uruzgan Province, Afghanistan, according to the Associated Press.
So grave is the problem that U.S. Max Baucus, D-Mont., has secured an amendment to the National Defense Reauthorization bill that will create a comprehensive and standardized suicide prevention program for military service members. U.S. Sen. Jon Tester, D-Mont., the state’s only member of the Senate Veterans Affairs Committee, co-sponsored the measure.
“This is about taking care of these men and women, just as they have taken care of us,” Baucus said. “These people have put their lives on the line in the name of freedom. We have a responsibility to do everything we can to help them return to their families and lives back home.”
The amendment, which passed the Senate last month, is known as the Mental Health ACCESS Act and is headed to the president for his signature. The provision will:
• Create a comprehensive, standardized suicide prevention program within the Department of Defense;
• Expand eligibility for VA mental health services to family members of veterans;
• Create more peer-to-peer counseling opportunities; and
• Require the VA to establish accurate and reliable measures for mental health services.
More Montanans per capita volunteered for service after 9/11 than anywhere else in the country. There are nearly 300 Montanans currently serving in Afghanistan.
“Montana’s military men and women make tremendous sacrifices on the battlefield, but too often they return home with wounds unseen,” Tester said. “This measure makes sure we live up to our responsibilities to them and puts everyone on the same page when it comes to making sure our hardworking men and women get the care they earned.”
Deploying to Iraq and Afghanistan isn’t the only risk factor in solider suicides. In 2010, at least 54 percent of the U.S. military suicides had no history of deployment and 89 percent had no combat history, according to the U.S. Defense Department’s Suicide Prevention Office.
Military leaders are working to emphasize that seeking help is a sign of strength and courage, not weakness.