By CPT Patrick Twomey, M.D., U.S. Army

A lack of suicide intervention has affected my own life deeply. When I was a sophomore in high school, one of my best friends handed me what I thought was a Christmas card. She handed them out to a bunch of our friends. She was always very cheerful and was the kind of friend to do such things, but I did think it was a little weird when she said not to open it until that night.

Curiosity got the better of me and I opened it in my French class the following period. To my shock, it was a suicide note. She thanked me for being her friend for years, and explained she was going to kill herself that afternoon. I tried to find her after class, but she had gone home early. I agonized over whether or not to call her parents or tell a teacher, but decided not to because this was probably a cry for help and she’d be mad at me. I’d just call her later and talk to her.

Since the end of DADT, the ability for LGB service members to unite and speak about issues openly has been refreshing and productive. These discussions have generated timely, important topics. As a doctor, I am often asked about the topic of LGBT health care, and while I am always happy to address that issue, it is extremely broad. One specific subject which comes up repeatedly, both in the media and on OutServe chat groups, is the topic of suicide.

As we all know from training session after training session, suicide has become a major concern in the military over the past 10 years. Since 2001, roughly 2,300 service members have taken their own lives. This is a staggering number, considering the relative combat-related fatalities of U.S. military personnel (4,408 during the Iraq war, according to the Department of Defense). With that in mind, and coupled with the recent tragedies of LGBT youth taking their own lives after years of psychological torture by the words and actions of bullies, it doesn’t take a giant leap to conclude that LGBT service members have a higher risk of suicide than the average American.

The most important point to understand is that suicide can affect anyone, and it is extremely important to recognize the signs early and get help immediately. The vast majority of suicides and suicide attempts are NOT simply mild cries for help. They are typically reactions to extreme stressors (either real or perceived) in which the person with the suicidal thoughts fully intends to follow through.

This is important to understand when your battle buddy or shipmate calls you at 11 p.m., drunk, making out-of-character comments like, “I’m just tired of it all, it’s hopeless!” or “I found out my partner’s been cheating on me for several months, I just can’t live without him!” If you suspect something is wrong, it likely is. Don’t expect that your battle buddy or shipmate will just shrug it off and be fine in the morning.

So, what should we as a community do to combat this problem? What can we do? Recently, there has been a substantial push to involve social networking sites. The Surgeon General of the United States and the National Suicide Prevention Lifeline announced in December they will be partnering with Facebook to add a reporting page for questionable posts.

In this system, people will be able to anonymously report posts suggestive of suicidal thoughts to a page. A message will immediately be sent to the person in question directing them to a hotline, or allowing them to join a live chat with a counselor for assistance. VADM Regina Benjamin and the National Suicide Prevention Lifeline, as well as Facebook, should be commended for this idea, as it shows a desire to coopt new technology to help combat this issue.

One important point: if you do suspect a friend of having suicidal thoughts, or they are posting unusual or concerning statements on their profile page, please make sure that you make personal contact with them in addition to contacting the appropriate help. Make contact to not only show that you care and are concerned, but also to make sure they are talking to someone until they can speak with a mental health professional. Never leave a suicidal person alone.

Okay, so what are some of the warning signs to look for in a friend? How can you tell when someone is just feeling down or having a bad day, or truly contemplating suicide?

In short, ask them. If they appear more depressed or hopeless about their situation, engage them in conversation and assess how they view their current position. Most of us will feel depressed about something once in a while. That’s perfectly normal.

We will all experience the death of a loved one, breaking up with a boyfriend or girlfriend or a spouse, deployments, or moving to a new assignment away from friends and family. It would be odd if we didn’t feel bad about these situations. Take cues from how they talk about it. Listen closely to hear if they are sad, but still hold hope for the future. If they’re PCSing, do they make plans about coming back to visit or having you and others visit them? If they’re deploying, are they making plans for when they return or for a mid-tour leave? If they broke up with a partner, do they talk about taking time for themselves to feel better or make plans with friends to cheer them up?

These are all good coping mechanisms to stressful situations and can help gauge if this is normal grieving or something worse. Signs which could indicate more than just normal sadness include:
• Sleeping too much or too little
• Excessive use of alcohol or other drugs.
• Deteriorating physical appearance, personal welfare (i.e. failing a PT test/weigh-in).
• Partaking in risky activities (i.e. unprotected sex, drinking and driving).
• Deteriorating work performance (perhaps you’re picking up their slack).
• Giving away prized possessions.
• Feelings of guilt, desperation, hopelessness, or even rage.

As a friend, what should you do?

The first thing to do if you suspect someone is going to hurt him/herself is to talk to them about it in a non-threatening manner. If you are near them, be with them in person. If not, call them and don’t let them off the phone.

The important point is: do not leave them alone. Take them seriously! Don’t belittle or make light of their situation, though to you it might seem small or completely manageable. Call for appropriate help, even if that means 9-1-1. Suicidal thoughts must be treated like any other life-threatening situation. If you saw an intruder break into a friend’s house with a gun, would you think, “yikes, that sucks,” and hope the intruder just goes away, or would you call the police? Suicide is a permanent reaction to a temporary problem. The following are helpful hints when in this situation:

• Talk directly. Listen. Do not judge. Take the threat seriously.
• Do not dare them to do it. Don’t make light of the situation.
• Don’t be shocked. Empathize with their situation.
• Do not swear to secrecy. If someone says they’re going to hurt themselves, get help.
• Assess if they have any means of committing suicide (i.e. weapons in the house, stockpiles of pills, including over-the-counter pills, which are just as dangerous as prescription pills in large quantities), and mitigate these threats if possible.
• Get help from any of the numbers or agencies provided below immediately!
• If the person is in the process of hurting themselves (i.e. swallowed pills, etc.), call 9-1-1 immediately.

What if you are the one hurting? What if you are the one that finds yourself in a situation where you are actually experiencing suicidal thoughts? It’s not as far-fetched as it seems. Life can certainly throw curve-balls your way, and though many military personnel are adept at coping, humans can only endure so much on their own. The important points to understand if you find yourself in this situation are:

• There are people that want to help. There are people that do care about you and want you to get better.
• Talk to your friends first. Often, your friends can be the ones to make you feel better and show you ways through what you perceive to be hopeless situations.
• Call the numbers provided, even if you don’t feel like talking.  You can always simply listen.
• Avoid alcohol! This can’t be overstated. You cannot “drink your problems away.” Alcohol takes away your inhibitions; what would ordinarily be a fleeting thought of hurting yourself in a desperate time, becomes something you act on and never take back. Think of all the times you’ve done something stupid while drunk—at least you have a chance to apologize the next day. Suicide is final. If you are feeling depressed, do not drink!
• Utilize your medical services. We really want to help you. I have met many good people in my years as a medical corps officer and physician. In addition to physicians and psychiatrists, the clinical psychology program is a tremendous organization of professionals with a wide breadth of experience who are trained to help you as well. One important thing I would like to convey and have seen in practice is that the stigma of seeking help for these issues has been dramatically reduced. Our primary goal is your health and safety, so please don’t be ashamed to talk.
• Utilize your chaplaincy. Despite what is appearing in the media about some members of the chaplaincy reacting negatively about DADT ending, I have worked with some incredible chaplains in the past. Chaplains knew I was gay, and chaplains have helped LGBT service members through relationship issues just as they would our straight counterparts. Chaplains get excellent training on these matters. Don’t be afraid to talk to them. If you know for a fact that they do not approve, or you’d rather not talk to one, you can always seek a referral to speak with someone else.

When I got home from school that day, I tried calling my friend–she didn’t pick up. I got a little nervous. I ended up swallowing my pride and called her mom. Sure enough, she had taken a whole bottle of sleeping pills and was taken to the hospital.

She survived. She was not happy with me immediately after this event, and we really didn’t speak much through college. We re-connected a couple years ago and I came to find out she is now married with three beautiful children and loves her life.

Suicide is a permanent decision. There is no coming back. It’s never the answer. As a friend, deciding to help a friend in need is always the right decision.

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Important Information to Remember:

A: Ask your friend directly if they are thinking of hurting themselves.
C: Care for your friend. Don’t leave them alone. Empathize with them.
E: Emergency care. Call for help. Call 1-800-273-TALK (8255) and press 1.

Online: www.VeteransCrisisLine.net

Merely going to the link above does not automatically connect you to someone, so feel free to explore the site. These services are free and counselors are trained in LGBT sensitivity. Use these if you are thinking about suicide or think someone you know is.