But let's take this a step further. Just as it seems reasonable to ask whether intensive media coverage could be a contributing factor in rising military suicide rates, it also seems worth considering whether DOD's own intensive focus on suicide prevention might be having have a similarly unintended effect.
On Fort Carson, for instance, as it any other large military installation, it's hard to get through a day without seeing the word "suicide" over and over. News of suicide prevention stand-down days is posted on bulletin boards and written up in newsletters; posters highlight suicide prevention resources. At Fort Carson's main gate, a neon sign flashes the word "SUICIDE" in foot-high red letters. (I'm pretty sure the sign said "Prevention Week" in smaller letters down below the word "suicide," but even driving past at a sedate 15 miles an hour, "suicide" was the only word that registered.)
I spoke to Commander Steven Bartell, Deputy Director of DOD's Suicide Prevention Office, and asked if he was concerned about the potential for imitative suicides. "There are a lot of precipitating factors" for suicide, he said, and "it's hard to say what are the major contributing causes.... But all that being said, is there a potential for contagion? The obvious answer is yes."
In practice, it's virtually impossible to assess whether any "contagion effect" resulting from suicide prevention programs themselves is negligible or substantial. But in theory, said Bartell, "Even trying to raise awareness can put a thought there that wasn't there before....It's a challenge."
It is indeed. How do you raise awareness of suicide prevention resources when talking about suicide may, in and of itself, increase the prevalence of suicide? "There may be a Catch-22 here," Commander Bartell observes ruefully.
Is there any way out of that Catch-22? I don't know, and the experts don't know, either. But here are a few ideas.
For one thing, the media could do a better job of self-policing when it comes to stories on suicide, and DOD could do a better job of ensuring that reporters are aware of public health guidelines on suicide reporting. DOD public affairs officials say that though they conduct internal training on how to discuss suicide responsibly, concerns about being perceived as trying to stifle press freedom mean they don't systematically push such information out to reporters.
I think that's a mistake: there's nothing in the First Amendment that says DOD can't hand out copies of the World Health Organization's recommended media guidelines to reporters asking about suicide in the military. Some media outlets will ignore the recommendations, but at the moment, many reporters are unaware that there's even an issue.
DOD could also do more to increase awareness of suicide contagion within the military, perhaps developing internal program guidelines on how to reduce the likelihood of imitative suicide, similar to those other organizations have developed for the media. While we don't have much solid information on whether suicide prevention efforts carry their own contagion risks, there's enough evidence of contagion resulting from media stories to suggest that DOD should err on the side of caution in its own programs.
That doesn't mean eliminating suicide prevention programs, of course -- ignoring the issue most certainly won't make it go away. But it does suggest increased care in the use of the term suicide, as well as training for caregivers, leaders, and gatekeepers in how to talk about suicide without inadvertently contributing to the problem of imitative suicides.
Overall, we know dismayingly little about what constitutes an effective suicide prevention program, but research suggests that problems with alcohol, drugs, depression, mental illness, finances, and relationships can all be risk factors for suicide. Studies also suggest that service members often lack the concrete skills needed to access behavioral health and other resources, making it less likely that they will seek help even when helpful resources exist.
What this implies is that you don't necessarily need to label something a "suicide prevention program" for it to have a suicide prevention impact. Indeed, it may well be that many of the most effective suicide prevention tools never use the word "suicide."
Resources:
For more information on suicide best practices, see this 2011 RAND report and this 2012 report from the Military Suicide Research Consortium. You can find CDC media guidelines on reporting on suicide here, NIMH guidelines are here, and the WHO guidelines are here. You can get more information on DOD suicide prevention programs here. If you or someone you know is in crisis, call DOD's suicide prevention hotline: Dial 1-800-273-8255 and press "1."
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