Soldiers in Alaska say they wait months for mental health appointments and "feel blamed" by leaders when a fellow service member takes their own life.
These challenges, along with the financial strain of living in a high-cost region and simply being "unprepared" for the state's long, dark days and sub-zero temperatures, raise concerns that the Army and the Department of Defense health system are failing soldiers at risk for suicide.
But the problems aren't confined to Alaska or the Army.
Despite spending billions on suicide prevention programs in the past decade, the Defense Department and the military services are falling short in helping struggling service members, lawmakers and witnesses said during a House Armed Services personnel subcommittee hearing Wednesday.
"Some of the challenges are unique to Alaska, but many are not: crushing op tempo, under-manning, financial insecurity, toxic command climates, easy access to lethal means and lack of timely access to care," said subcommittee Chairwoman Rep. Jackie Speier, D-Calif.
Since 2014, 4,842 service members have died by suicide, including the active duty, reserves and National Guard. Suicides among active-duty personnel reached 384 in 2020, a 44% increase from 2015.
Last year in Alaska, at least 11 soldiers died by suicide, with six additional deaths under investigation. And in the last six months alone, eight troops have died of suspected suicide.
"The trends are not going in the right direction," conceded Karin Orvis, director of the Defense Department's Suicide Prevention Office, in the hearing. "Over the past two years, we've seen a slight decline nationwide for our U.S. population, but that does not hold for our young males in our U.S. population, and that's consistent with what we're seeing in the military."
Beth Zimmer Carter, a retired Army lieutenant colonel whose son Chris died by suicide in 2015, said more needs to be done at the unit level to root out toxic leaders and personnel who shame, harass or bully those who are struggling.
Carter said when her son used marijuana to self-medicate after experiencing trauma and head injuries during four deployments to Afghanistan, Army leaders isolated him, made him clean latrines and called him a "pothead."
"They did all of this just after losing another battalion member to suicide," Carter said.
Bonnie Carroll, president and founder of the Tragedy Assistance Program for Survivors, said the services must eliminate this type of behavior in the ranks.
"Those who stigmatize care, harass, bully, isolate or unfairly punish service members interested in their mental health care must be held accountable," Carroll said. "Leadership must endorse this help-seeking behavior as a sign of courage and strength and prioritize mental fitness."
According to Speier, the Defense Department claims soldiers assigned to Alaska can get a telemedicine appointment for mental health within seven days, or 12 days for an in-person appointment.
But "without commanders around, soldiers on the ground told me what actually is happening," she said. "They typically wait two months. … What's more, because providers routinely quit ... soldiers' treatment is often interrupted."
The crisis in Alaska has prompted leaders to mandate wellness checks with counselors for all soldiers assigned there.
During a press conference last week, Maj. Gen. Brian Eifler, commander of U.S. Army Alaska, said leaders will be reaching out to all troops' spouses or next of kin, and therapists will check on all soldiers.
"Mission 100 is a campaign to connect with 100% of our soldiers -- leaders connected with the soldiers and soldiers connected with each other," Eifler said, according to Stars and Stripes.
In addition, the Army has invested $214 million in its installations to improve soldiers' quality of life, with better food in chow halls and upgraded fitness centers. It is introducing monthly readiness training to improve unit cohesion through recreational activities and adventures. The service also is bringing in experts to teach soldiers coping skills and resiliency.
But more needs to be done at other installations and throughout the system to halt the troubling trend, lawmakers said.
"We need to do more," Speier said. "Providers are leaving because the conditions are so difficult and the workload or the caseload is so high."
"We must take steps needed to look at this holistically and figure out how to do better from a personnel perspective," said Rep. Mike Gallagher, R-Wis., the subcommittee's ranking member.
Orvis and Dr. Richard Mooney, acting deputy assistant secretary of defense for health, said suicides are caused by a complex number of factors, making it difficult to develop prevention programs.
But, Mooney added, "data suggests that we're trending in the right direction."
"This is suggested by increased demand for mental health services, which indicates that service members feel less reluctant to get the help they need and deserve," he said.
According to DoD officials, the department is launching an initiative this month to encourage service members and military families to safely store firearms and medications in order to prevent instant access and will train non-medical providers such as counselors on suicide risk and safe storage of weapons or drugs that can be used in a suicide.
The DoD also plans to increase the number of telehealth appointments by more than 64,000 -- a number Mooney said will help roughly 8,000 service members get better access to care. And it is changing its staffing model to "match supply and demand across the system."
But Craig Bryan, director of suicide prevention at Wexner Medical Center at Ohio State University, said that the majority of DoD prevention programs focus on awareness, screening, anti-stigma campaigns and mental health treatment -- an approach he said is "fundamentally flawed" because it assumes that suicide risk is a characteristic or trait of an individual.
"Suicide is not just caused by something inside service members; it is caused by complex interaction between service members and their environments. Context matters -- organizational culture, institutional practices and community conditions impact suicide risk, just as much, if not more, than the service members' internal mental resiliency," Bryan said.
Speier, who has announced she is retiring at the end of this year, promised to make the DoD's suicide prevention efforts one of her "top priorities" in the defense bill, requiring evaluations of programs and "changes to stop hemorrhaging mental health providers."
"We must do everything we can to break the chain of suicide. This problem could not be more urgent," Speier said.
Service members and veterans experiencing a mental health emergency can call the Veteran Crisis Line, 1-800-273-8255 and press 1. Help also is available by text, 838255, and via chat at VeteransCrisisLine.net.
-- Patricia Kime can be reached at Patricia.Kime@Monster.com. Follow her on Twitter @patrciakime.