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| Col. John Bradley |
November 26, 2010 — Col. John Bradley, MC, is an eighth-generation soldier. A member of his family has served in every conflict since the Civil War. So when he tells you that psychiatric casualties — the invisible wounds of war — take a far greater toll on those who serve than bombs or bullets, you believe him.
His military awards include the Bronze Star, the Meritorious Service Medal, the Army Commendation Medal, the Army Achievement Medal, the National Defense Service Medal, the Iraq Campaign Medal, the Global War on Terror Service Medal, the Humanitarian Service Medal, the Army Service Ribbon, the Overseas Service Ribbon, the Polish Multinational Division Service Medal, and the Order of Military Medical Merit.
He learned from his father and his grandparents what it is like to be a soldier and the unique stresses and strains that military personnel face. He also learned these lessons first-hand when he participated in Operation Iraqi Freedom as a member of the 528th Combat Stress Control Detachment.
Col. Bradley, the first in his family to become a physician, earned his Doctor of Medicine from the Uniformed Services University in Bethesda, Maryland, and trained in psychiatry at Letterman Army Medical Center in San Francisco, California.
His passion to care for troops motivated him to become a psychiatrist.
I learned early on that more than half of the casualties that we experience in any operation are psychiatric casualties.
"I've always been interested in military history, and I learned early on that more than half of the casualties that we experience in any operation are psychiatric casualties. That's where I felt compelled to exercise my efforts," he told Medscape Medical News. "I know from my family history what pressures soldiers face. I have studied not only interpersonally through narrative histories but also by studying the literature about the psychological effects."
Col. Bradley now heads the Department of Psychiatry at Walter Reed Army Medical Center and the National Naval Medical Center in Bethesda, and is vice chair of the Department of Psychiatry at Uniformed Services University.
Military Suicide at an All-Time High
Currently, the suicide rate among armed services personnel is the highest it has ever been in the country's history.
He also recently headed up an independent Department of Defense (DoD) task force struck to find ways to stem the growing number of suicides among military personnel. Currently, the suicide rate among armed services personnel is the highest it has ever been in the country's history.
Medscape Medical News asked Col. Bradley about the challenges the task force faced and what solutions it proposed to solve the problem.
"Our mandate was to look at suicide prevention at the systemic level, across the DoD. Our charge was to understand all of the different programs, make recommendations for best practices, and coordinate suicide prevention efforts across the DoD," he said.
"Primarily, services develop their own suicide prevention programs, so the biggest challenge that we faced as a task force was learning everything about what each of the services — the Army, Navy, Air Force, and Marine Corps — were doing in their respective programs. It was a huge task."
The first job was to find a mix of civilian and military experts on suicide to staff the panel. Next, civilians had to be brought up to speed on "military speak" — that is, they had to learn the military jargon, culture, and organization.
Task force members shared what they knew about suicide prevention, evaluated suicide prevention policies and procedures in various installations across the country, and compared those to best practices.
"We knew that suicide is a growing problem. . . . We first wanted to benchmark what each of the different services were doing, and we found that they have been doing a tremendous amount," Col. Bradley said.
Prevention Efforts Fell Short
"The DoD is the only organization on the planet as an employer that really looks at suicide prevention from a populist health and wellness perspective," he said.
"That's unheard of in any other military or civilian employer or any other organization, so we wanted to mention the dramatic efforts that have been launched in trying to deal with the growing suicide problem in the DoD."
As it turns out, these efforts haven't been good enough.
Ever since the DoD began measuring suicide rates among its ranks in the 1980s, the rate has been roughly half that of civilian control groups. This began to change in 2001 to 2003, when suicides in the military began to climb; in 2009, the rate of suicides in the Army and the Marine Corps approximated the civilian rate.
"That protective effect . . . in the military no longer seemed to be protective, because for the first time we saw that active-duty members were dying of suicide at rates that were equal to the civilian population," Col. Bradley said.
The task force concluded that the reason for this rise in suicides was because the armed forces were out of balance.
The operational demands on the force. . . exceed our human capacity to meet that mission on a day-to-day basis.
"The operational demands on the force. . . exceed our human capacity to meet that mission on a day-to-day basis. This has primarily to do with operational tempo in the wars in Iraq and Afghanistan," he explained.
Operational tempo is the number of times that an individual is gearing up for combat, is deployed, and then returns, he added.
Unprecedented Pattern of Deployment
The demands placed on soldiers and their families are extraordinary.
"The demands placed on soldiers and their families are extraordinary. They're deployed to combat for a year, come back for a year, and return again. This places tremendous strain on service members."
This pattern of deployment is unique to the Iraq and Afghanistan wars. "It's distinctly different from how we've deployed in the past. In World War II, soldiers were enlisted, they went to combat, and they stayed in combat until the war was over. They didn't come home and then return.
"In Vietnam, the majority of soldiers went for 1 tour; they served a year and they came home. In more recent operations, like operation Desert Storm, troops went for the duration, but that was a limited engagement. So this is unique, sending people repetitively, and it certainly does place extraordinary strain on our force," Col. Bradley explained.
Col. Bradley hesitates to say that this pattern of deployment is entirely to blame for the high suicide rate.
"Data tell us that one third of the people who die by suicide in the army have never deployed; one third have a history of deployment and commit suicide after returning home from combat, and one third occur in troops who are currently deployed to Iraq or Afghanistan."
Changing Culture
The good news about suicidal thinking and behavior is that it is treatable, said Col. Bradley. "It's often related to an underlying depression, family problem, or legal problem that can be solved, and we can help the vast majority of people with suicidal crisis regain their health and functional ability."
The task force is encouraging soldiers to seek help when they feel they are getting into trouble. It is also encouraging military leaders to engage and begin to develop a culture where health-seeking behavior is rewarded.
"One of the analogies I use personally when talking with troops is this: I remind them that they rely on their vehicles to get around the battlefield, and [ask them if their] engine is idling roughly, do they just keep driving and wait until the engine is blown or do they take that vehicle offline and get it fixed. If we take that much care of our Humvee, we should take that much care of ourselves, as people and as soldiers," Col Bradley said.
To this end, an assertive strategic communications campaign led by senior DoD officials aims to get this message across.
"We've tied in with living Medal of Honor recipients to talk about the need to take care of yourself, to optimize your mental health, and take care of yourself in a crisis.
"We also have what we call a Real Warriors campaign, similar to last decade's Real Men campaign run by the National Institutes of Mental Health, which said, 'Real men get treatment for depression.' The current saying is 'Real warriors take care of themselves' — which tells our soldiers that yes, this affected me and I got help and I'm better, and if you get help, you'll feel better as well."
Deploying to combat essentially doubles a soldier's risk of developing illnesses such as posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, or alcohol abuse.
This information campaign is normalizing the fact that 17% to 18% of troops meet the criteria for some mental disorder. Deploying to combat essentially doubles a soldier's risk of developing illnesses such as posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, or alcohol abuse.
Mental Illness Is an Occupational Hazard
"We have to recognize that this is an occupational hazard, that it's normal. You are not crazy if you develop any of these conditions; this is a result of your service, and you ought to allow the service to take care of you," Col. Bradley said.
He emphasized that there is no shortage of places that soldiers who fear they are sliding down the slippery slope toward suicide can go for help in today's armed forces.
"We're very fortunate in the DoD to have ready access to behavioral healthcare. There's probably no healthcare organization in the country that has more robust capabilities in terms of mental healthcare and — particularly for troops in combat — we have a higher concentration of behavioral health practitioners in Iraq and Afghanistan than we do in the United States.
So behavioral healthcare is readily accessible," he said.
Col. Bradley admits that suicide prevention is a challenge, but it is possible.
"The challenge is to make sure that the 19% of people who need help reach out and get that help, and that we provide the highest quality of care to them.
"Major depressive disorder is treatable. PTSD is treatable. Suicidal crisis is treatable. The challenge is making sure that those who need help step forward, ask for the help they need, and get the treatment that will help them regain their lives."
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Cite this: Army Psychiatrist Battles the War on Military Suicide - Medscape - Nov 26, 2010.
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