Feature Article
Recognizing the need
FACT
From 1990 to 1994 suicide was the second leading cause of death (after unintentional injuries) among active-duty U.S. Air Force personnel, accounting for 23 percent of all deaths.
FACT
During this time span the annual suicide rate among active-duty USAF personnel increased significantly from 10.0 to its peak in 1994 at 16.4 suicides per 100,000 members. Rates were rising for both African-American and Caucasian males ages 24 to 35.
FACT
Less than one-third of suicide victims had accessed Air Force mental health services before their deaths. Yet 25 percent of these victims had legal problems, frequently with the military justice system. Yet a mental health specialist had evaluated less than one in five.
“Come on over and talk to me about these suicides.”
It was the message Thomas S. Moorman, Jr., then vice chief of staff for the Air Force, sent to USAF Surgeon General Chip Roadman.
Moorman, a four-star general and second in command over 350,000 active-duty Air Force personnel worldwide, was troubled by rising suicide rates within his ranks. So troubled that he mandated in 1996 that suicide prevention become a service-wide priority. And he looked to Chip Roadman to carry that mandate out.
“It's in our (USAF) culture to be concerned about our most valuable resource - people. … In a general sense people were cognizant of it (the rising suicide rate in the USAF) and worried about it,” recalls Moorman. “But when I questioned the staff regarding suicides during briefings, they didn't seem to know much. So I said to the surgeon general, ‘Chip, come on over and talk to me about this. I may be wrong, but I believe by and large that suicide is a failure of the system.’”
Roadman recalls that first meeting with his superior officer.
“Suicides were being inspected by OSI (Office of Special Investigation) and lamented by the chaplains. Everybody had a pixel of the problem, but no one had put it together to form the entire picture,” says Roadman, who took a novel approach to curb suicide rates, one tied to the business principle of TQM or total quality management.
“I'm an obstetrician and gynecologist by training and a flight surgeon. So I know about cause and effect in medicine,” notes Roadman, recalling this first meeting with Moorman to consider how to curb suicide rates. “Suicide is an effect. It's an outcome measure of something upstream. So what is the root cause? If you approach it medically you say, ‘I’m going to prevent suicide.’ But that's not possible; you can't do it - unless you look upstream at the causes. You’ve got to pull the entire community together. So you look to the concept of total quality management.”
Total quality management, or TQM. It's a philosophy that permeates the best and most successful organizations. TQM infuses a culture with a commitment to customer satisfaction through continuous improvement. And Chip Roadman felt that its principles were a key to stemming suicide in the Air Force.
Roadman began by commissioning a team of experts representing 15 functional areas to conduct a systematic study of the issue and recommend a prevention strategy. The team, under Roadman’s leadership, was comprised of military and civilian personnel (see below).
Roadman remembers well his first words in summer 1996 to the newly assembled team.
“I pulled them all together and I apologized for being a medical doctor,” recalls Roadman. “I told them, ‘Just because I’m a physician, don't think suicide is a medical problem’ There's a place for the medical model…but we can't assume the medical model is the only approach. It's not just about diagnosable mental illness but some behavioral issues, some life situation issues.”
Roadman notes that anyone with a diagnosable mental illness is discharged from the Air Force. So suicidal impulses in members of the Air Force were perhaps driven less by dys-function of the brain and more by other things. The challenge? To identify those other causes - and develop a program to address them, thereby curbing suicide and saving lives.
Team participants
About 75 people - both military and civilian - participated in the formation team for the U.S. Air Force Suicide Prevention Program. They include:
Within the USAF
Military and Civilian Personnel
Chaplains
Safety
Staff Judge Advocate
Commanders
First Sergeants
Child and Youth Programs
Family Support
Family Advocacy
Law Enforcement
Office of Special Investigations
Epidemiology
Mental Health
Preventive Medicine
Outside the USAF
Centers for Disease Control and Prevention
Armed Forces Institute of Pathology
Walter Reed Army Institute of Research
