Suicide crisis in the military fueled by ineffective screening for brain injuries

The Department of Defense’s oversight chief in March acknowledged something critical in the quest to stamp out suicide among current service members and veterans: that the armed forces are woefully ineffective at screening service members for traumatic brain injuries and for following up with those that suffer from them.

It’s an important finding because brain injuries — which can be mild to severe — are suspected as a major cause of suicidal behavior. The lack of effective screening and follow-up could at least partially explain the crisis of suicides plaguing veterans and current service members, something many veteran advocates have been saying for years.

“Nearly half a million service members suffered traumatic brain injuries (TBIs) in the past two decades, but the Defense Department isn’t sure exactly how many, how they are being treated or how they are doing now,” says Military Times, summing up the findings of the Inspector General report.

As the IG notes about what it calls “one of the signature injuries of troops wounded in Afghanistan and Iraq,” the military health system “did not consistently identify and assess patients with TBIs; the DoD did not implement consistent processes for the management of TBI care; and the DoD did not implement consistent processes for the disposition of care, including return to duty status for patients diagnosed with a TBI.”

The bureaucratic-speak belies the gravity of the findings.

A major concern about brain injury, especially for service members and veterans, is the link to suicide. As the Department of Veterans Affairs noted in its 2020 annual report on suicide among veterans, “Veterans Health Administration patients who died by suicide are more likely to have sleep disorders, traumatic brain injury or a pain diagnosis than other VHA patients.” Similarly, a study in the journal Psychological Servicesfound that post-9/11 veterans with a history of traumatic brain injuries were at much greater risk for considering suicide.

Service members often sustain what is known as mild traumatic brain injuries. In the military, mBTIs are common place and can be sustained in many ways, “including athletics, recreational activities, physical training practices, … falls, motor-vehicle accidents and exposure to explosive blasts,” researchers reported in the Journal of the Alzheimer’s Association. These can be just as dangerous if left undiagnosed.

The pictured painted by the Department of Defense Inspector General is one of neglect – only 41 percent of patients diagnosed with mild traumatic brain injury received follow-up appointments within three days, and only 33 percent of patients with mild TBIs completed a 72-hour follow-up.

What’s more, the 14-page intake form that military medical staff use to help diagnose the injuries “fallsto the wayside because it is not useful and takes too long to complete,” according to the report.

The report is another glaring reminder that the government simply isn’t doing enough to take seriously the connection between brain injuries and suicidal behavior among service members and veterans. With the initiative I lead, that issue is front and center. We are raising awareness about the connection through an effort known as National Warrior Call Day on Nov. 12, which asks that all Americans connect with veterans and service members and in turn get them connected to supports and services.

The Pentagon counters that it is taking greater action to identify and treat the range of brain injuries suffered by service members, but the reality of 20 years’ worth of ineffective diagnosis and treatment is deeply troubling for what it portends about suicide rates into the future.

The IG report, the Military Times wrote, underscores that the Pentagon is still trying to grapple with the invisible wounds of war, “after two decades of combat in the Middle East and South Asia, which means such injuries could plague the military population for decades to come, unacknowledged and untreated by the military health system or the veterans health system.”

Unless and until the government can do a far better job identifying and treating those with brain injuries and conducting robust follow up when they leave military service, the suicide crisis will forever remain a national tragedy.

A former Navy SEAL, 40th U.S. Senate Sergeant at Arms and father of a Navy SEAL son who died by suicide, Larkin is chair of Warrior Call.