Suicide takes growing toll among military, veterans

Louisville   CourrierJounal.com
http://www.courier-journal.com/article/20090913/NEWS01/909130330
Suicide takes growing toll among military, veterans
By Laura Ungar • lungar@courier-journal.com • September 13, 2009

As soon as Arylane Ala walked into her house that day in 2007, she saw blood — a red pool stretching from the coffee table to the fireplace. Then she saw her youngest son face down on the floor, an antique rifle by his side.

She didn’t approach his body, she said: “I didn’t want to see his face … his expression.”

Four tumultuous years after serving in the Middle East with the Kentucky Air National Guard, 25-year-old Bryan Ala of Louisville took his life — part of a rising number of military and veteran suicides as the Iraq war continues and fighting intensifies in Afghanistan.

“Life goes on after you lose a child,” said Bryan’s father, Rich, 60. “But sweet is never as sweet as it was. The sun’s never as bright. I’ve got a hole in my heart that will never heal up.”

The federal government estimates that 5,000 veterans commit suicide each year, and Dr. Thomas Insel, director of the National Institute of Mental Health, said suicides among Iraq and Afghanistan veterans could top combat deaths.

He made the statement last year at the annual meeting of the American Psychiatric Association and cited a study by Rand Corp., a nonprofit research organization, showing as many as 20 percent of veterans returning from these conflicts will suffer major depression or post-traumatic stress disorder, and seven in 10 won’t seek help from the departments of Defense or Veterans Affairs.

The toll is also rising in the active military, with the Army reporting the most confirmed suicides — 140 last year. Locally, Fort Knox reported five confirmed suicides in 2008 and 2009. Fort Campbell reported 24 suspected or confirmed suicides in the same period and in late May suspended regular duties for everyone for three days so commanders could better help soldiers at risk.

Driving these numbers are pre-existing mental illnesses, post-traumatic stress disorder and relationship or financial problems worsened by long or repeated deployments, say mental health experts, who also point to the stigma against seeking help in a culture known for toughness.

Many families and veterans organizations argue that more needs to be done to stop the deaths. And military and Veterans Affairs officials say they are taking the problem seriously, beefing up mental health resources and suicide prevention programs.

“We’ve got to hit it head on,” said Maj. Gen. Donald Campbell, Fort Knox commander.

In July, Fort Knox played host to Maj. Gen. Mark Graham of Georgia and his wife, Carol, who told a standing-room-only crowd about the 2003 suicide of their son Kevin, 21.

The ROTC cadet at the University of Kentucky suffered from depression before his sister found him hanged from a bedroom ceiling fan. The Grahams, who have made military suicide prevention a personal cause, shared Kevin’s story before attending a ceremony dedicating a building to their other son, Jeffrey, who was killed in action in Iraq in 2004.

“We lost two sons,” said Mark Graham, who spoke again on Aug. 21 in Frankfort. “Both our sons died fighting different battles.”
History of mental illness
Mental illness also proved too strong an enemy for Bryan Ala.

Growing up, he was adventurous and loved caving, rock-climbing, fishing and going to the shooting range with his father, a Vietnam vet. At 18, Bryan Ala joined the Air National Guard to help pay for college, later enrolling in the University of Louisville’s nursing school.

Depression first struck in the summer of 2002, and Ala admitted himself to Ten Broeck Hospital, now called The Brook. He was prescribed an anti-depressant, his parents said, and later in the year saw a doctor at Fort Knox who determined he was fit to stay in the Guard. He was deployed the next year to the Middle East.

Capt. Stephanie Fields, deputy state surgeon for the Kentucky National Guard, said soldiers are not deployed if they have been diagnosed with depression less than three months earlier because the soldier needs to show stability. But otherwise, she said, decisions are made on a case-by-case basis, according to Army policy, by a treating physician who consults with the soldier’s commander. If they are deemed too ill to deploy, she said, they may still be able to stay in the Guard. Fields said soldiers have two mental health evaluations before deployment.

Rich Ala said he worried that serving abroad might aggravate his son’s depression, but didn’t say anything because he figured his son was an adult who could take care of himself.

Bryan Ala spent six months as a medic in Saudi Arabia, the United Arab Emirates and Qatar, where his job was to care for an air crew and help at a military field hospital. He didn’t talk much with his family about what he saw during his tour, beyond the different cultures and the harsh conditions of a desert tent encampment.

Back in the United States, he served another six months as a medic with a hospital group at the Kentucky Air National Guard base in Louisville, and his parents said everything seemed fine.

But in 2004, they began to notice troubling signs. Arylane Ala said her son always wore black and went on binges with vitamins, nutritional supplements and workouts. Sometimes he would hide, saying he heard helicopters. And he would get extremely agitated while driving, occasionally slamming his car into park, and running away, disappearing for hours or even days.

In June 2005, Ala was hospitalized at the Louisville VA Medical Center and diagnosed with bipolar disorder, which the VA later ruled service-connected, which made him eligible for financial benefits.

He was prescribed lithium, but his parents said he sometimes skipped his medication. At nursing school, he highlighted passages about bipolar disorder in his psychiatry textbook, writing “me” in the margins.

Finally, after a fight with his fiancee that resulted in her obtaining an emergency protective order against him, Bryan Ala went to his parents’ home. The Alas said he promised not to do anything rash. But after they went to work on Aug. 10, 2007, he took a rifle from under his father’s bed and ended his life.
Combat haunts vet
Psychologist Lanny Berman, executive director of the American Association of Suicidology in Washington, D.C., said the military generally does a good job screening out people with severe mental conditions.

But he said many soldiers suffer pre-existing depression or develop mental illness during or after service — magnifying everyday stresses and compromising already disrupted relationships.

Berman, who serves on a federal task force to prevent military suicides, said the Iraq and Afghanistan wars pose the particularArmy Sgt. Cecil Harris of Pikeville, Ky., was one of them. After serving in Iraq in 2003, he was flown to Germany with respiratory problems, severe headaches and a bacterial illness, said his mother, Sharon Harris of Louisville.

But long after the physical healing began, she said, his combat memories haunted him, and he was diagnosed with PTSD at the Lexington VA hospital.

In May of this year, in the midst of a divorce, he called his mother in Las Vegas, where she was working as a traveling nurse. He talked about difficulties with a new medication.

On May 17, Harris, 33, was found hanged from a beam of an apartment under construction in Danville.

His mother recalled his last words to her:

“Promise me, Mom, if something happens to me, that you’ll be my voice to the boys who come back so they get better medical treatment.”
Care gets beefed up
Military and VA officials said they are trying to do just that.

Nationally, the VA has suicide prevention coordinators in each of its hospitals and in 2007 started a suicide hot line for veterans that has received more than 120,000 calls. The Louisville VA Medical Center provides mental health care and outpatient group sessions for once-suicidal veterans.

Joe Verney, suicide prevention program manager at Fort Campbell, said his was the first Army installation in the continental United States to create a council of leaders from medicine, religion, behavioral health and other disciplines, in 2007, and to hire a suicide prevention coordinator, in 2008.

The base also contracts with 29 behavioral health professionals available for round-the-clock, anonymous consultations, and trains soldiers in a suicide-prevention program called “Ask, Care, Escort,” which stresses accompanying others to help.

Fort Knox officials said they are taking similar steps, trying to eliminate the stigma against seeking help.

“Our Army is clearly moving in the right direction,” said Mark Graham, who used to command Colorado’s Fort Carson. “But it’s not moving fast enough.”

The changes come too late for the Alas, who argue that mental health needs to be treated like physical health, with the ill getting intensive treatment.

Arylane Ala said problems with mental health care in the military and VA reflect problems in the larger civilian culture. “Mental health in general … should be more readily available,” she said. “People should be treated more frequently. Having a (psychologist) to speak with every three months is not enough when the illness is serious.”

Two years after their son’s death, she and her husband often visit his ashes at a cemetery near Fort Knox, placing plastic toy soldiers nearby to symbolize his service.

“You hope nobody goes through the loss of a child,” said Arylane Ala, her eyes filling with tears. “Life’s not meant to be that way.”

Reporter Laura Ungar can be reached at (502) 582-7190.

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