AWOL: Soldiers and Suicide
The caller wasn't coherent.
All I could gather was that he'd been to Iraq and now he thought he was going crazy. At first he wasn't talking about what was wrong with him, but what was wrong with his insurance coverage. He was rambling, yelling, cussing, crying. I thought he was a recent veteran, but then it sounded like he was still active duty. I couldn't tell if he was out of the military or still in it. He wasn't able to answer my questions, so I let him vent for a while.
When he stopped to breathe I asked: "you mean you're active duty, now? You're in the military?"
Well sir, right now I'm AWOL.
"Oh. Well, where are you?"
I'm in [state].
"Why did you go there?"
It's where my family is. My insurance told me I won't be covered out-of-state unless I have an emergency. I don't have an emergency. If I can find a way back to [state] can I get into your place?
"Yes, probably. But tell me what's going on. What kind of problem are you having?"
I want to fucking die.
The caller went on to describe anxiety, depression, and suicidal ideation. We talked about that until he was able to contract for safety:
Supportive engagement with a suicidal patient requires active work in seeking a less pessimistic perspective on problems and dividing them into lesser units with greater chances of solution. For protracted suicidal risk, many mental health professionals use a "therapeutic contract for safety," essentially an agreement to seek help before acting on a suicidal impulse.
In this case, it didn't take a lot of "supportive engagement". The only "lesser unit" we addressed was that he should seek treatment immediately and locally and not worry about traveling across the country. The caller calmed down once I started talking about staying where he was and sticking close to his family.
This isn't a case about care that wasn't available. Nor is it a case of his insurance company misleading him or denying care. They told him and he repeated to me that he can only get care in another state if it's an emergency. The problem was that he didn't know what that meant. He didn't understand that this was an acute psychiatric emergency and would be recognized as such by any hospital or insurance company. It's as much an emergency as if he were bleeding uncontrollably or having chest pains. That's not common knowledge and it should be.
Public Service Announcement:
If you walk into ANY hospital in these United States and say anything along the lines of: "I'm having thoughts of suicide and I'm afraid I am going to hurt myself," you will be treated or referred to treatment . You should expect and demand to be treated regardless of your ability to pay just as you would if you were bleeding uncontrollably or having chest pains.
A more troubling "lesser unit" was his statement that he started having problems because his CO took his medication away.
"Your who did what?"
What he told me his Commanding Officer said was part of an incoherent rant early in the call. It was something like: quit being a fucking pussy with your happy pills. It reminded me of a quote I used before:
I was appalled by the article bl968 found:
"The individual has got to take personal responsibility. They have got to take responsibility for themselves and realize that they can save their own lives. It comes back to the individual." -Gen. Jeffrey Schloesser, Commanding General at Fort Campbell on soldiers and suicide.
In other words, JUST SAY NO to suicidal ideation.
Man-up and get over it.
Whoa... slow down, Francis. . . . [to self, not to the General or the caller]
Disclaimer 1: A CO taking prescribed medication away from a soldier is an extraordinary claim for which I have no evidence. This is a completely unverified statement by a deeply troubled young man. When I tried to ask him more about exactly what happened he began to flare up again, so I let it go.
Disclaimer 2: I've been purposely vague in details of the actual conversation and I've taken care to not quote the caller exactly. This is due to HIPAA privacy laws. I feel safe that I am not violating HIPAA because I don't use any specific details or specific quotes and this is not breaking news in that the call did not occur recently.
I offered to look up facilities in his area but he'd already done that. He knew the locations of local facilities that he knew could help him but he thought he wasn't allowed to go to any of them.
There's a stigma attached to psychiatric care among the general population. People are reluctant to seek care or even talk about it with friends or family. I imagine this is considerably amplified within Armed Forces populations. Here's a public service announcement from the Substance Abuse and Mental Health Services Administration (SAMHSA):
It's a start. It's a strong ad. However, I only saw it because I searched youtube for it. Maybe there should be funding for ads like this to be aired often enough to actually penetrate. Maybe there should be a PSA that defines acute psychiatric emergency for people and lets them know when to come into the hospital or call 911. Along with the big-picture drive to get soldiers/veterans all the benefits they need and don't have, maybe there should be funding for PSA's that target them and keep them informed on how to access the benefits they do have.
I don't know what the caller faces with regard to his AWOL, but I'm glad it will be his MD and not his CO leading him in this battle for his mental health.