Asking the Hard Questions – Suicide Prevention

By LT Erika “Misty” Anderson, USN

I was on holiday leave back in 2017 when I got a call from a friend in my Fleet squadron. I had just walked out of a Kona Coffee on Maui and took the call without thinking, assuming it was just a funny story from a night out, or a question about workups. The last thing I expected to hear was, “Misty…he killed himself.” The green cliffs in front of me slid out of focus and I heard a buzzing in my ears. My stomach dropped, and the humid air suddenly felt cold. All I could get out was, “…What? No, he didn’t.”

My friend had called to inform me that our fellow former squadron Junior Officer had committed suicide. In the days, weeks, and months afterward, my mourning squadron couldn’t make sense of it. With every crack of the 21-gun salute in the USS Midway’s hangar bay, the location of the memorial service, things seemed to add up less and less. . How could someone so vibrant, so personable, so alive, just simply not be here anymore? An HSC FRS instructor, mentor, friend, brother, and son, he was dedicated to his job and had made plans for the future. No one saw it coming.

But…should we have?

Anyone who has been in the Navy for more than one tour has most likely been around suicide, whether it be ideations, plans, or actions. I have been to many suicide prevention trainings in which the briefer has asked us to raise our hands if we’ve been affected by suicide while in the service. Nearly every hand goes up, every time. In fact, a study on suicide conducted by the U.S. Department of Veterans Affairs (VA) last year yielded some alarming results: in a breakdown of both men and women, and those who are civilians or veterans/active duty service members, the study found that veteran/active duty males are nearly two times more likely to contemplate, attempt, or succeed in suiciding than are their civilian counterparts. For veteran/active duty females, that number is almost five times greater than that of civilian women.

But why?

While I saw fewer cases of suicidal ideations and attempts at my Fleet squadron, I have had quite a different experience on my shore tour at HSC-2 as an Instructor Pilot with the collateral duty of Suicide Prevention Coordinator (SPC). While the FRS is a much larger command that’s staffed with a significant number of non-deploying personnel, I think a bigger difference is that I really started paying more attention. As the SPC, I generate a SITREP every time one of our Sailors is admitted to the psychiatric ward at Naval Medical Center Portsmouth – after my fifth or sixth SITREP since accepting the job, I did some digging.

Suicide and military service have lead an embattled coexistence since the conception of an organized fighting force. While post-traumatic stress disorder (PTSD) was only just accepted by the American Psychological Association as an actual mental health disorder in 1981, it has run rampant across the ranks for decades, the first documented cases of “shell shock” appearing in World War I medical journals for both American and British fighters. While PTSD has been mistakenly referred to exclusively as a “soldier’s disease,” we now know that only about 10 percent of modern cases of

PTSD are combat related, and that the condition can actually originate from many other sources. The VA’s aforementioned study on veteran suicide cited many causal factors of PTSD while in military service, most notably longer times at war or on deployments, more severe deployment conditions, brain or head trauma, and life-lasting physical injuries. For every SITREP I have filed for a suicidal Sailor, one or more of these causal factors have been present in any particular situation and exacerbated by continued service. Reflecting upon the two past unconventional years our fighting force has experienced due to COVID, deployments have certainly changed, toughened, and lengthened. Multiple unplanned months at sea, coupled with an absence of port calls, has compounded the severity of these factors across the Navy and led to a record high of suicidal ideations and attempts in Fiscal Years 20 and 21.

People are typically familiar with the most common signs of suicidality: talking or writing about wanting to die, harboring feelings of hopelessness or having no reason to live, losing interest in activities, increasing the use of alcohol or drugs, sleeping too much or too little, and giving away possessions. But sometimes, the signs can be…nothing at all. Thoughts or words of “I had no idea” or “I never would have imagined this” are common sentiments in these cases. When I’m approached by a suicidal Sailor’s division officer, or Chief, or friend, it reminds me that it is often difficult for people to ask the questions no one wants to hear: “Are you thinking of hurting yourself? Have you thought about suicide?” But after 21 SITREPs written, I am eternally grateful that the program seems to be working. Because while I was initially frustrated with the sheer volume of cases, doubting that we were helping anyone at all, my Skipper so eloquently put it: “Misty, the ‘P’ in SPC is working – prevention. We just need to think about the ‘P.’” I will write one million more SITREPs for ideations in order to get people the help they need if that means I never have to activate a CACO due to a successful suicide attempt.

I believe things can get better. Aside from SERE school, the Navy’s ASIST (Applied Suicide Intervention Skills Training) course has been the best military training I’ve ever received. I’ve had multiple Sailors, Fleet Replacement Pilots, and even fellow Instructor Pilots approach me about mental health resources, or come to me to tell me that the counseling they’ve been pursuing is really helping them. This makes me feel so hopeful for the future. I am glad that my generation and younger ones are so much more open to the idea that mental health is equal to physical health in terms of its legitimacy in warranting medical attention. In my nearly nine years of service, I’ve noticed a huge shift from an outdated dichotomy that’s told us a strong leader is only strong if they approach their charge with stoicism, and without emotion. In contrast, I believe the ability to empathize with peers and subordinates is part of what makes a leader strong. Asking for help isn’t a weakness. Asking for help won’t get your wings or qualifications pulled. And asking for help certainly won’t make me see any of my Sailors or peers as “less than.” In fact, I feel great relief every time I can refer someone to Military OneSource or Fleet and Family Services, because progress, no matter how small, is being made. I tell my students that they can’t expect to fly well if their head isn’t in the right place, and I wouldn’t expect my Sailors to perform at their best if their mental health took a backseat to all of their other tasks and responsibilities. While it has taken years to get to this place, we are finally accepting that mental health IS physical health, and that we will be better individuals, and a better Navy, for it.

I implore everyone to ask the hard questions. Pay attention to the signs, or, as I sometimes refer to them, the “not signs.” While it may feel incredibly intrusive, be the steward that your Sailors, your peers, and your friends need you to be, even if they don’t ask for it. It could save a life. And while we, as mere pilots or aircrewmen, are not medical professionals, it does not take a medical professional to care about this danger that lurks in the dark corners of another extended deployment, or a stressful home life, or a seemingly hopeless situation. Caring is free. Having empathy costs nothing. Attempting to understand the battles of others, even the silent ones, is not a weakness. It is the pillar of commonality I have found in all the leaders I have loved serving under, and for whom I would drop everything to work for again.

They all understood and demonstrated, time and time again, that our most precious asset needs protecting – not helicopters, ships, or equipment, but people.

I think often of the friend I used to know. His name was Alec and he was a wonderful human being. While my time knowing him was brief, I remember him as kind, caring, and empathetic. Every time I talked to him, he listened like I was the only person in the room. He told me he was considering applying for the Career Intermission Program to pursue medical school, and he told me he was so happy to have me in the Wardroom. While I did not get the opportunity to know him as well as I would have liked, those who knew him best spoke endlessly of his selflessness and care for others. His loss is still so very deeply felt, even these years later.

It poured on the day of Alec’s memorial, and anyone who has lived in San Diego can tell you what a rarity that is. I watched the rain come down in sheets as we all struggled to the Midway in our SDBs, thinking it was no coincidence that the day we remembered an extraordinary person was the same day the skies decided to open above us. Afterward, we all waded our way down the street to The Waterfront, Alec’s favorite bar. His framed picture still hangs there to this day, right under our squadron plaque. My last visit there, I noticed a spider web crack in the glass of the frame, and was immediately upset that someone had done that – until the bartender told me that a group of his friends had come in and had raised a glass, and apparently toasted him with a little too much enthusiasm, causing both the beer glass and picture frame to shatter.

I like to think he would have laughed at that.