For the men and women of the U.S. Armed Forces, coming back home should be a time for celebration, not sorrow. Yet as the drip-drip-drip of military suicides continues to make the front pages of local newspapers, the reality is anything but cheery, and increasingly the first source of news isn't the local newsreader or reporter--but Facebook and Twitter. Yet as John Winn discovers, social media and the Internet can be a help as well as a hurt. The military is already harnessing the Web to reach out to disaffected vets--but are the troops listening?
Michael LiPani and Brad DeLorme never imagined that they'd use the bulk of their free time advocating for suicidal veterans. By their own accounts, the Rochester, New York residents--and high school seniors-- were focused more on baseball than basic training. But that all changed when a routine class project became unexpectedly personal.
"We started this Facebook page as a part of our Participation in Government class," LiPani said via a message on the social media site. "PIG is a class all seniors take at Irondequoit High School. For our final project, we got to pair up and pick a topic to inform our classmates about[i]."
The subject: military suicides.
It wasn't an easy topic for either of them. While most students are happy to talk about youth apathy or women's rights, the pair chose a topic that is almost impossible for many teenagers to understand, much less research. Getting veterans to open up about their wartime experiences is famously difficult, and the two teen's experiences were no different.
Without knowing who to talk to, what questions to ask or even a road map, the duo spent several weeks researching the subject, consulting Google and Wikipedia, and for a time, the local library became a common hangout to share notes, swap tips--and dig for information.
"Neither of us had training in social work," LiPani said. "Since we were still seniors in high school. We picked this story because we both plan on being in the military sometime after high school and we saw how our heroes, our soldiers, had to face thoughts of suicide and PTSD."
So LiPani and DeLorme did what came naturally: they grabbed their camcorder, and pressed record. Though the constraints of school, and baseball, kept them from a more thorough investigation, they did manage to speak with an employee of a military crisis hotline, and what the man told them opened their eyes.
Using statistics obtained from the Department of Defense, LiPani and DeLorme were able to estimate that 27 percent of all noncombat military deaths were suicides--including servicemen and women who were never deployed to the battlefield. The teens also found that 18 veterans take their own lives each and every day.
But that wasn't the scariest news they discovered.
"The most shocking of all we learned," LiPani said. "is that there is little being done to help these soldiers in need."
According to statistics from the Congressional Budget Office, nearly 187,000--or 27 percent-- of veterans of Operation Enduring Freedom and Operation Iraqi Freedom have been diagnosed with some form of PTSD or traumatic brain injury[ii]. PTSD and TBI are two of the contributing factors to depression and suicide in vets.
[AU3] The teens' presented their findings to a class full of students, but the duo did not stop there. Inspired by what they learned, they decided to raise awareness about the dangers veterans suffering from PTSD and suicidal ideation suffered when they returned from the battlefield.
And so, the Preventing Military SuicidesFacebook group was born on December 21, 2011--four days short of Christmas.
Since then, the group has developed a modest following, with a handful of friends and 69 likes to its name. Preventing Military Suicides is especially popular with the 18 to 24 crowd--prime recruiting age for enlistees. Though the group is primarily confined to a small group of high school friends, the passion and enthusiasm they share is hard to dismiss.
LiPani and DeLorme aren't the only ones advocating for suicidal veterans. OhMyGov located at least one other group on Facebook based out of Kileen, Texas[iii] dedicated to helping veterans and their families share their experiences with PTSD, depression and suicidal thoughts, as well as a Facebook group titled "Military Suicide: Reality and Solutions[iv]".
The administrator of the "Military Suicides Facebook Group" declined to comment on the group's whereabouts, or its activities.
Though suicides arerarely forecast on the Web, several high-profile cases illustrate the role in which social media either helped veterans--or pushed them closer to the edge.
Shortly before his death last November in Afghanistan, Private Danny Chen wrote a Facebook message to a friend living in New York City.
"It sucks here all sandy and everything," the Sept. 20th message to Raymond Yam reads. "prob gonna b bak May-June one of those i have no idea but whatever.[v]"
Two months later, Chen was found dead in a guard tower in a U.S. outpost in Afghanistan, the victim of a self-inflicted gunshot wound. He was 19 years old.
Chen--a member of C Company, 3rd Battalion--had been bullied by his fellow soldiers in the days leading up to his death. According to the website Bowery Boogie, Chen had been taunted with racial slurs, put in a 'simulated sitting position' during which he was kicked by other soldiers using their knees, and in one incident, made to wear a green helmet and shout orders in Chinese (Green helmets are occasionally worn by PLA soldiers during operations and war games)[vi].
In all, eight individuals would be charged in connection with Chen's death--including West Point graduate Daniel Schwartz. If convicted, four of the eight face three years in a military brig[vii].
The phenomenon isn't isolated to the U.S. Army. Two years earlier, a Canadian intelligence specialist was found dead on a Kandahar base. Major Michelle Mendes, an instructor at the Royal Military College in Ottawa, was just a few days into her deployment when her body was found April 23, 2009[viii].
Mendes had previously described her deployment on Facebook as going well, crediting her transition to the battlefield to the balmy spring season ('"The Afghan heat hadn't yet flared",' the Toronto Star paraphrased her as saying).
Mendes showed no outward signs of depression, PTSD or traumatic brain injury. Although she did suffer an undisclosed injury during Operation Medusa, the Canadian army's clash with the Taliban in the nearby district of Panjwaii, the military would say little else at the time.
The Canadian military officially concluded its investigation into Mendes' death in August 2010[ix]. Like Chen, Mendes had suffered a single, self-inflicted gunshot wound. She was one of sixteen Canadian soldiers to take their own lives in 2009, and the third female to die since Canadian forces were deployed during the current Afghan mission.
It is difficult to say what exactly goes on in the mind of a suicidal soldier, yet the epidemic of suicides is so vast that the U.S. Army has issued its own report about the crisis within its ranks. "Army 2020: Generating Health and Discipline in the Force Ahead of the Strategic Reset" spares no hard feelings about the problems the branch faces. The 183 page report details everything from at-risk populations, the impact of PTSD and traumatic brain injury on depression and suicidal ideation, drug and alcohol abuse, and the role of PTSD stigma in discouraging soldiers from seeking out help[x].
In a press conference in January 2012, General Peter Chiarelli, the man tasked with overseeing the task force looking into suicides in the Army, laid out the scope of the crisis in front a room filled with reporters from The New York Times, The Washington Post and various wire services[xi].
The news isn't good. According to Chiarelli, a record 164 soldiers, National Guard troops and reservists took their own lives in 2011--a slight uptick from 2010, but far from the doomsday scenario that journalists had been reporting prior to the release of the report.
Reaching out to these populations has never been easy for the Army--or soldiers, for that matter. The rough and ready nature of the armed forces--and the negative stigma behind counseling--prevents many soldiers from getting the help they need. According to the Army's own figures, the incidence rate of mental illness diagnoses shot up from the peacetime number of 6,000 per 100,000 persons in 2000 to well over 12,000 by decade's end[xii].
Yet the military community, in combination with business and the federal government, is stepping up to reach out to a new generation of soldiers, sailors, and Marines returning home from Iraq and Afghanistan.
Their secret weapon: social media.
Launched in collaboration with the Rush University Medical Center and the Give An Hour charity, an organization connecting veterans with veterans, Vets Prevail[xiii] is but one example of the outgrowth of social media outreach towards combat veterans with PTSD, TBI and other trauma as a result of their combat service. But whereas traditional methods involved face-to-face or telephone contact, Vets Prevail is totally digital.
Once a veteran logs on to the site with a handle and password, he (or sometimes, she), has instant access to cognitive behavior therapy-based learning sessions, peer-to-peer support, and if they really need it, one-on-one counseling with a professional counselor. The 'full spectrum mental health solution[xiv]', as the Vets Prevail site calls it, is one of many points of entry outside the bureaucratic maze of VA and the Department of Defense, providing stigma-free options for mental health support.
Modeled after Weight Watchers online and other, civilian websites, members receive a customized treatment program based on an online assessment, network with peer coaches and experts, and generally develop a support network to help them through their treatment. There are even awards for progress, hinted at cryptically by a bag with a gold coin resting beside it.
The program is so successful that a national rollout kicked off in December 2011. The program has the support of not only the Veteran's Administration and the Robin Hood Foundation--a New York City charity serving low-income veterans--but also Goldman Sachs.
The government has its own presence on social media as well. The Veteran's Administration looms large on Twitter and Facebook, sendingover 2300 tweets to its nearly 40,000 followers on its main Twitter account alone[xv]. That's in addition to the agency's 263,000 Facebook fans, giving them a total of 303,000 fans across both sites.
A separate Twitter account, @veteranshealth, has garnered over 13,000 and over 3,000 tweets[xvi]. But whether servicemen and women are listening is another question.
The impact of social media in mitigating--or spreading--suicide contagions is one of the most heavily debated questions in academia. Organizations as diverse as the American Journal of Public Health[xvii], Student Pulse[xviii], and other organizations have looked at the impact of social media on the civilian population (including gays and lesbian teens). A handbook for suicide prevention has even been issued for practitioners and the media, detailing the dos--and don'ts--of discussing suicides on social media[xix].
For some people, social media is a curse. For veterans, it can be a godsend, and for the families of soldiers and sailors serving in Iraq and Afghanistan, it is often the front lines in a war against depression and suicide.
At least, that's what Daniel L. Elliott found out when he set out to survey wives and husbands of deployed service members serving in Iraq and Afghanistan. In 2011, the Wake Forest graduate--and Army officer--launched an unprecedented thesis[xx]examining the role Facebook plays creating support networks that Army wives and families can lean on to cope with the absence of their soldier, sailor or Marine while he or she was off on assignment.
With the approval of officials at the Army's Institutional Review Board and Family Readiness Support Assistants--the military's social workers for families of deployed soldiers-- participants were selected from units based in Fort Hood, Texas and Fort Drum, New York, respectively. Of Elliot's initial 4,500 person sample, over 200 participants--mostly females--volunteered for the study. In the case of the 10th Mountain Division's Combat Aviation Brigade, which had been deployed in August 2010, some had been separated from their partner for at least nine months.
Elliott quizzed them about a battery of questions, from deployment stressors, Facebook use, and perceived support online. His findings were jaw dropping. Though many felt lonely following their spouses' deployment, when it came to Facebook, nearly 75 percent--154 of the women in the sample--expressed a positive correlation between their Facebook use and online emotional support.
Just as many received tangible benefits from the networks they created--such as tips on counseling and other resources--that later proved useful in getting their own husbands help when they returned home.
Referring to an earlier study of deployed soldiers conducted in 2009, Elliott noted the effect resiliency--or to put it another way, grace under pressure--had on service members and their families.
The point isn't lost on the author.
"The survey results obviously demonstrate that the wellness of the Army and spouse and family at home, can have a negative effect on the deployed soldier," Elliott wrote. "and unmistakably reinforces why support is necessary for soldiers and family members remain at the forefront of the Army's effort to make them cope."
"Facebook, Resilience and Army Spouses Coping with Combat Deployment" was published last year. It is the largest study of its kind looking at Facebook use among the spouses of service members stationed abroad. But it is the larger point he raised--about creating an environment that allows support networks to flourish, so that service members and their families find the help they need before they end up in trouble--that is making a larger impact.
One part of that network is internet based counseling. And it works.
Just ask Birgit Wagner.
When Wagner's colleagues at the University of Leipzig in Germany wanted to know if Internet-based therapy would be effective in treating victims of torture in Iraq, they went straight to the source. Translating a Western treatment manual into Arabic, they educated Iraqi practitioners in the how-tos of Internet-therapy, stepped back and let the therapists do the rest of the work.
The results were astonishing. After several weeks of treatment, patients reported a dramatic decrease in PTSD, depression, and anxiety symptoms[xxi].
"To our knowledge, this is the first study which used e-mental health technologies in the treatment of PTSD in an (Arabic), conflict country[xxii]," Wagner said in an email interview. "The Treatment Centre for Torture Victims in Berlin has a number of treatment centres in Iraq, however, the number of traumatized people is very high and there is a demand for more widespread intervention."
Getting the pilot study off the ground wasn't easy. According to the Brown University's Watson Institute for International Studies, 3.7 million refugees have fled Iraq since the U.S.-led invasion began in 2003, many of them psychologists, psychiatrists and clinical social workers--the type of professionals who are most qualified in assessing and treating patients[xxiii]. In Wagner's case, the study took five years to complete as the team started from scratch, training an entirely new set of practitioners how to interact via the website they founded in 2006.
In many instances, the typical patient was able to terminate their relationship with their therapist, although some kept in contact with them long after the sessions ended. Since the pilot study ended last year, the website has been expanded and greatly improved. Because of concerns surrounding client security, the researchers have no plans to launch a social networking component of the site.
"Regarding difficulties--of course needless to say we experienced a number of difficulties." Wagner said. After we finished the RCT for PTSD in November, we started with another RCT for PTSD and one for depression, both of course in Arabic."
If a pilot study of Iraqi refugees can successfully treat refugees, is a program for NATO soldiers not far behind?
Wagner is not so sure.
"Currently we are not aware of any programs which are aimed at soldiers suffering from PTSD being still in the conflict area," Shesaid.
Still, that hasn't stopped researchers in the U.S. from wanting to find out if a similar approach would work here. That is the focus of the Center for Mental Outcomes Research Center in Arkansas. Spearheaded by Dr. John C. Fortney, a veteran of depression, PTSD and TBI research, the ongoing survey is one of the most far reaching of its kind in the state. With only 265 participants, it is also one of the most difficult the center has undertaken.
"We enrolled 265 patients from 11 community-based outpatient clinics who met clinical criteria for PTSD according to the CAPS," Fortney said in an email interview[xxiv]. Recruitment was somewhat more difficult than our trials for depression, perhaps because avoidance is a symptom of PTSD. But veterans have a strong commitment to helping other veterans, and I think that motivates to participate in trials like this."
At first, patients were reluctant to participate in the survey, but once they did, the results were surprising. Nearly 238 of the 265 participants in the study--90 percent--have completed the scheduled research assessments according to Fortney, and by all accounts they seem to be responding well to counseling.
While Fortney would not answer any questions about the type of patients involved, the length of treatment involved, and how telepsychiatric services were being used by the sample (whether it was being used as a supplement to traditional counseling or a substitute, for example), the findings are consistent with a previous study conducted by the University of Arkansas Medical System in 2007 that found that depressives undergoing telepsychiatry experienced a better health-related quality of life than depressives who didn't receive treatment[xxv].
Six months after starting telepsychiatry treatment, most of Fortney's participants in the 2007 study were adhering to some form of traditional therapy, such as medication, and nearly 77 percent reported a positive encounter with a mental health specialist or telepsychiatrist--many of them VA employees as well. The success of that study, in part, influenced the VA's decision to fund the current study, which will wrap up in September 2012.
The final chapter in the four year saga that is #MHI 08-0891 has yet to be penned, but it is not just veterans and Iraqis who are benefiting from telepsychiatry. From North Carolinians to Alabamans, children and adults, there doesn't seem to be anyone who isn't a fan of it. Even The New York Times wrote a profile of the trend, noting the potential benefits--and pitfalls[xxvi].
Yet the positives seem to outweigh the negatives--and anyway, with so many people carting laptops and iPads, does it make any sense to pay $60 a week for gas when you all you have to do to see a therapist is pull up Firefox?
The universality of telepsychiatry is so mainstream that the VA has a website dedicated exclusively to telepsychiatry and telepsychology services. Vssc.med.va.gov is part of a nationwide model within the VA[xxvii]. According to Fortney, the intranet site delivered over 500,000 telehealth services to over 50,000 veterans in the year 2010 alone--no small feat considering the difficulties getting veterans to get help--let alone acknowledge that they need it.
In the meantime, LiPani and DeLorme are hoping that even if they reach one person,that is enough to stem the tide of deaths sweeping military bases across the country.
"The biggest thing we would wish people would know about [military suicides] is that the transition from military life to civilian life is a big step," LiPani said. "andsometimes adds to the stress these soldiers face. These men are heroes and save our lives each and every day...so it is time to save their lives when they return to the United States of America".
[i]LiPani, Michael. Interview with author. 10 April 2012. Facebook message.
[ii]Congressional Budget Office. "CBO Testified on the Potential Costs of Health Care for Veterans of Recent and Ongoing U.S. Military Operations". cbo.org. http://www.cbo.gov/publication/42208. Created 27 July 2011. Accessed 2nd May 2012.
[iii]"Military Suicides Facebook Group". http://www.facebook.com/pages/Prevent-Military-Suicides/328462820505301#!/profile.php?id=100001739462375. Accessed 2nd May 2012.
[iv]"Military Suicide: Reality and Solutions". Facebook group. http://www.facebook.com/#!/pages/Military-Suicide-Reality-and-Solutions/119564101433579?sk=info. Created 10 April 2010. Accessed 20 April 2012.
[v]Semple, Kirk. "Grief and Suspicion Follow a U.S.Soldier's Death". The International Herald Tribune. 1st November, 2011. NEWS, pg. 1.
[vi]Bowery Boogie. "Shocking Details of Private Danny Chen Case Revealed". http://www.boweryboogie.com/2012/01/shocking-details-of-private-danny-chen-case-revealed/. 6 January 2012. Accessed 2nd May 2012.
[vii]Shapiro, Julie. "Accused Soldiers in Danny Chen Death Will Not Face Manslaughter Charges". DNAinfo.com. 6 March 2012. http://www.dnainfo.com/new-york/20120306/lower-east-side-east-village/accused-soldiers-danny-chens-death-will-not-face-manslaughter-charges. Accessed 2nd May 2012.
[viii]Woods, Allan. "Military Probes Death of Major; Intelligence Specialist Found Dead in Her Room at Kandahar Airfield Within Days of Arrival". The Toronto Star. 25 April 2009. NEWS, pg A03.
[ix]Brewster, Murray. "Forces closes books on officer's suicide, but troubling questions persist". 680 News. http://www.680news.com/news/national/article/87150--cf-closes-book-on-officer-s-suicide-but-troubling-questions-persist. 10 August 2010. Accessed 2nd May 2012.
[x]Department of the Army. "Army 2020: Generating Health and Discipline in the Force Ahead of the Strategic Reset". 2012. Washington, DC. White paper.
[xi]Bumiller, Elizabeth. "Active Duty Soldiers Take Their Own Lives at Record Rate". The New York Times. 19 January 2012. Pg. A13.
[xii]Army 2020. Figure II-1. Page 13.
[xiii]Vets Prevail Home Page. http://www.vetsprevail.org. Created 2012. Accessed 23 April 2012.
[xiv]"The Vets Prevail Program". Prevail Health Solutions. Winter 2011. White Paper.
[xv]Veterans Health Twitter Account. http://twitter.com/#!/veteranshealth. Accessed 23 April 2012.
[xvi]Luxton, David D, Jennifer June, and Jonathan Fairall. "Social Media and Suicide: A Public Health Perspective". American Journal of Public Health. May 2012. Vol 102, number S2.
[xvii]Mensinger, Maxwell G. "Fraternity and Social Change in the Digital Age: The It Gets Better Project in the March of Online Fraternity". Student Pulse. 2012. Vol. 4, Issue 01.
[xviii]O'Connor, Rory C., Stephen Platt and Jacki Gordon. International Handbook on Suicide Prevention: Research, Policy, and Practice. John Wiley and Sons. Chicester, UK. 2011.
[xx]Elliot, Daniel L. "Facebook, Resilience, and Spouses Coping with Combat Deployment". Wake Forest University. May 2011. Graduate Thesis.
[xxi]Wagner, Birgit, Wassima Schultz and Christine Knaevelsrud. "Efficacy of an Internet-based Intervention for Postraumatic Stress Disorder in Iraq: A Pilot Study". Psychiatry Research. January 2012. Vol. 195, Issue 1.
[xxii]Wagner, Birgit. Interview with author. 10 April 2012. Email.
[xxiii]"Refugees and Health". Costs of War. Watson Institute of International Studies. Brown University. 2011. White Paper.
[xxiv]Fortney, John C. Interview with author. 17 April 2012. Email.
[xxv]Fortney, JC, Jeffrey Pyne, and Mark Edlund et al. "A Randomized Trial of Telemedicine Based Collaborative Care for Depression". Journal of General Internal Medicine. 2007. Volume 22, Number 8.
[xxvi]Hoffman, Jan. "When Your Therapist is Only a Click Away". The New York Times. 25 September 2011. Page ST1.
[xxvii]Department of Veterans Affairs intranet. Accessed 20 April 2012.