This report originally published at allhands.coastguard.dodlive.mil.
Posted by PA2 Connie Terrell, Tuesday, January 23, 2018
Written by Chief John D. Miller, Fifth Coast Guard District
The last drill weekend she saw Petty Officer 1st Class Jose Christopher Trujillo-Daza alive, Petty Officer 2nd Class Natalie Crane ate lunch with her coxswain and section leader.
“He was sitting on the boat, and we were eating, and he said, ‘This right here, being on a boat with buddies? This makes it all worth it,’” Crane remembered.
A week later, Trujillo-Daza was dead, a victim of suicide. Crane and her fellow reservists at Port Security Unit 313 in Everett, Wash., were stunned. What had happened in the intervening days? What else could they have done to prevent it?
In the past five years, 10 Coast Guard reservists have died by suicide, an average of two a year. That percentage is lower than that of other military branches and on par with the civilian suicide rate. It’s also small enough that statisticians and health professionals have difficulty pinpointing patterns that would provide Trujillo-Daza’s shipmates reliable answers or contexts.
Yet even one death has a disproportionate enough impact on a unit—not to mention a challenge to the Coast Guard’s commitment to its people—that policymakers at Coast Guard Headquarters and civilian researchers continue to study how to improve suicide prevention programs, including for reservists.
“He knew that the resources were there,” said Petty Officer 1st Class David Pierce, Trujillo-Daza’s friend and shipmate at PSU 313, referring to the Coast Guard-sponsored mental health programs. “He just felt that [suicide] was his only way out.”
Beyond the chain of command or chaplains, the current Coast Guard Employee Assistance Program (EAP) is CG SUPRT. Advertised through flyers, general mandated training and on the service’s website it is available via a toll-free phone number 24 hours a day and seven days a week (including to reservists on- or off-duty). CG SUPRT is designed “to assist Coast Guard employees with a wide range of mental health and other life concerns, such as depression, relationship issues and work stress,” according to the website.
When members call CG SUPRT, “they’ll have an opportunity to speak with a licensed clinician with experience in these topics and with [a military] population,” explained Adrienne Wright-Williams, the Coast Guard’s Employee Assistance Program Manager, Office of Work-Life Behavioral Health Services Division.
“An assessment is done on the phone, and then they’ll refer the caller to medical services if it’s an emergency,” said Wright-Williams, ”but if not, they’ll continue with appointments and follow-up services for the members: call-backs and check-ins—checking in on them, asking, ‘can I provide you with more information, how are you doing?’—but also an appointment if necessary.”
Yet in spite of the mandated suicide prevention training and the promotion of CG SUPRT, Wright-Williams acknowledges there may be some people, like Trujillo-Daza, who may not be reached by—or reach out to—those services.
“We don’t want to think that, but sometimes there are conditions beyond our control,” she said. “But that shouldn’t stop you from trying to make [zero suicides] happen.”
The question then becomes what to do differently. Researchers say that looking beyond stereotypes is an important first step.
“There’s a natural instinct to think that a combat deployment would be a consideration in suicides,” explained Dr. Jackie Maffucci, research director for the non-profit Iraq and Afghanistan Veterans of America. However, “according to Army research, only a third of those who died by suicide had ever been in combat.”
Likewise, though anxieties about losing a security clearance or being negatively perceived by shipmates and superiors may still deter some people from asking for help, education since 9/11 on the psychological and emotional effects of military service have lessened the perceived stigma associated with mental issues.
“There is still some stigma, but it doesn’t seem to be much of a factor as we used to think,” said Dr. Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah. “Our research suggests that the reason people do not get help is not because of stigma, but whether the treatment is convenient and will really help.”
With respect to convenience and effectiveness, Bryan and Maffucci say that what may work for active duty personnel may not work for reservists like those in PSU 313 and other units.
“When it comes to Reserve versus active duty, you should be approaching prevention programs in different ways,” explained Bryan. “’One size fits all’ means one size fits nobody. The information can be the same, but it needs to be tailored.”
That’s because reservists experience stress in different ways. For example, instead of working every day with shipmates who may be trained to identify signs leading to suicide, reservists may demobilize from deployments or return from drills to homes far from their duty station. Perhaps the only service member within their community, perhaps in rural areas with access to few counseling resources, perhaps dealing with the stress of balancing a civilian career with a part-time military one, reservists may face a gradual, potentially deadly, accumulation of anxiety and stress.
That can be hard to detect on drill weekends.
“It’s pretty easy to put on a happy face for a two-day drill weekend and act like everything is fine,” says Petty Officer 1st Class Collin Woods, another shipmate and friend of Trujillo-Daza.
“In the Reserve, you can’t really see what’s going on with people in between drills,” said Woods. “You may say, ‘Hi, how you doing?’ and make small talk, but then you’re getting underway, so you can’t really feel them out. No one is going to jump in and start talking about their problems just because you say good morning.”
“He was also of the type that didn’t give out obvious clues,” said Pierce. “Some people will let you know about their suicide ideation or come out and say ‘I’m going to commit suicide.’ High performers like him aren’t going to let you know that.”
Because of these and other limitations, researchers advocate for a model of prevention for reservists that encourages early intervention to eliminate the causes of factors that historically result in suicide.
“I think we have to look at prevention from more of a community perspective, which we do a horrible job of in the U.S.,” said Bryan. “We’ve tended to . . . teach what warning signs to look for, what questions to ask, and, when there is a problem, who to call. What needs to happen is we need to move away from that model to one that’s focused on a day-to-day basis of maintaining health overall and not wait until we are in a crisis.”
Maffucci agrees. “There are a host of risk factors,” he said. “In over half of the cases of suicide, there is a mental health issue or illness there . . . but it could also be a build-up of a number of things—dealing with chronic pain, your spouse just left you, or your finances are problematic. And that’s the tough thing about suicide—it builds up over time. So we need to try and figure out the triggers early and get that trouble handled—refer someone to financial counseling or relationship counseling, for instance.”
Gaps in staffing have hampered continuity in prevention efforts, said Wright-Williams, including thinking about strategies and programs tailored for Reserve members. New to the position, she is now capitalizing on up-to-date research and data, including that shared by Department of Defense counterparts. She has already stood up a Suicide Prevention Charter Group that is at “the ground level now.”
Until a new, holistic, perhaps Reserve-specific, suicide prevention training and policy is rolled out, experts and enlisted personnel agree that communication is the best preliminary way that commands and peers can identify potential risk factors and locate that early help to remedy them.
“Leaders should check in constantly,” recommended Wright-Williams. “Send emails or reach out between drills—ask people how they’re doing, what’s going on.”
But Maffucci cautions that efforts need to be frank and sincere. “Part of it is leading by example,” he said. “The more leaders talk about this, especially the leaders right in front of you…, the more you’ll be saying it’s okay to ask and receive help.”
Crane, Pierce and Woods still puzzle about how they could have gotten help for their friend and shipmate, Trujillo-Daza. They knew he was mourning his mother, who died of cancer; that he had concerns about his career.
“We just didn’t put the puzzle all together,” said Pierce. “It’s up to us members to keep our eyes open and to keep talking to each other. We all need to talk.”
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