DSM5 in Distress

The DSM's impact on mental health practice and research

The Military Can Do More to Prevent Suicides

Reduce access to private fire arms and prescription drugs.

James Dao reports in the October 8, 2012 New York Times that the military is considering two steps to reduce its startling rate of active duty suicides- which is approaching an unacceptable one per day. Both measures are completely sensible, but neither goes nearly far enough. 

Privately owned guns and rifles are used in half of the suicides. The military would like to develop a program to engage friends and family in reducing the suicidal soldier's access to his own guns. Seems the perfectly obvious thing to do. Suicide in the young is almost always an impulsive act- the best form of suicide prevention may be to make it less easily accomplished. This approach is exactly what every mental health worker learns is a vital part of suicide management. In fact, not to try to separate the suicidal person from the suicidal means is sometimes considered a cause for a malpractice suit.

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But get this. As it stands now, commanders and military mental health personnel are by law not allowed to do anything about private firearms- even when a soldier is clearly at increased risk of killing himself. How can such foolishness possibly be? Last year the NRA pushed Congress into passing a law that forbids the military from any inquiry into the private firearms of its personnel. Just another obvious example of NRA's consistent over-reach beyond common sense or concern for public health and public safety. The American Foundation for Suicide Prevention is promoting a corrective new law, passed by the House but not yet by the Senate, that would restore the military's right to ask about (but not to confiscate weapons) when there is a high risk of suicide. This a small step in the right direction but obviously not far enough. It would seem a no brainer that gun safety for suicidal troops should trump NRA's political clout used to subvert even the most obviously necessary forms of gun control.

The military's second step would be to encourage friends and relatives to remove caches of prescription drugs collected by suicidal troops. Disturbing fact- one in eight soldiers (110,000) is on a psychotropic drug and polypharmacy with drug cocktails is rampant. Legal drugs have become a bigger problem than illegal street drugs- causing more overdoses and deaths. The military needs to go much further. Confiscating caches is far too late in the game. There needs to be re-education on proper prescription habits, greater coordination among multiple prescribers, and much greater control on how pills are distributed.

The military is to be commended for addressing its suicide problem- but it needs to get down to root causes and to implement the obvious solutions that might make a difference.

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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