Asking About Suicide Is Vital for the Military and Veterans

It’s every nation’s duty to protect its service members and veterans, and that includes urgently needed suicide prevention. For example, studies show that service members and veterans in the United States, compared with the general U.S. population, are at heightened risk for taking their own lives.

On average in the United States, an estimated 20 veterans die by suicide each day.

One recent federal government study found that the suicide rate among U.S. veterans who served on active duty between 2001 and 2007 was about 50% higher than the rate for their civilian counterparts. And in 2012 and 2013, more active duty U.S. service members died by suicide than in combat; only accidents, including transportation-related incidents, killed more.

Combat-related stress, family separation, mental and physical ailments, financial or relationship difficulties, and transitions back to civilian life are factors that can challenge a veteran’s mental health. Yet men and women who serve or have served in the military may feel they are jeopardizing their careers or showing “weakness” if they admit to having problems, making it difficult to identify who is at risk for suicide.

The Columbia Protocol Is Helping Save Lives and Target Resources

Proactively asking questions in a supportive atmosphere can be the best way to identify people who are at risk and get them the help they need. For example, the U.S. Marine Corps’ use of the Columbia Protocol as part of a broader suicide prevention program contributed to a 22% reduction in the number of active duty Marines who died by suicide in 2014. That’s one reason why the U.S. Department of Defense’s Suicide Prevention Office supports the use of the Columbia Protocol — also known as the Columbia-Suicide Severity Rating Scale (C-SSRS)  — across the entire U.S. military.

Every military organization worldwide can and should use the Columbia Protocol as part of a broader suicide prevention program because the risk detection tool is:

  • Simple. Ask all the questions in a few moments or minutes — with no mental health training required to ask them. The protocol can be used anywhere by anyone, such as a doctor in a health care facility, a counselor in a Vet Center, a chaplain in the field, or a commander within a unit — even by a soldier with a comrade.
  • Efficient. Use of the protocol redirects resources to where they’re needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help — and it makes it easier to correctly identify the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.
  • Effective. Real-world experience and data show that the protocol has helped prevent suicide. To make it even more effective for screening service members, The Columbia Lighthouse Project added questions based on military-specific risk factors.
  • Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research.
  • Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol to identify suicide risk, making it the most evidence-based tool of its kind.
  • Universal. The Columbia Protocol is suitable for all ages and special populations in different settings and is available in more than 140 country-specific languages.

“There is literally no other suicide screening measure that has as much predictive capability of future suicidal behaviors, is feasible for executing in the real world, and is as immediately clinically useful in saving lives.”

Millard Brown, Deputy Chief, Behavioral Health Division, Office of the Army Surgeon General

Success Story

U.S. Marine Corps: “Early Intervention Is Key”

When the number of suicides among active duty Marines jumped to 48 in 2012 and 45 in 2013 — up from 32 deaths in 2011 — the U.S. Marine Corps intensified its suicide prevention efforts. The comprehensive program includes early identification of at-risk Marines through the widespread use of the Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale (C-SSRS). In 2014, the number of suicides dropped to 34.

“Early intervention is key,” Maj. Gen. Burke W. Whitman, director of the Marine and Family Programs Division, told the House Armed Services Committee in October 2015. “A continuous challenge for the Marine Corps is to engage Marines in help-seeking services early, before problems worsen to the point of suicide.

“One of the most integrated suicide prevention efforts in the Marine Corps is the implementation of the evidence-based Columbia-Suicide Severity Rating Scale.”

The Columbia Protocol is used by Marine Corps community service behavioral health programs, chaplains, attorneys, medical staff, and financial counselors, as well as personnel in programs to help Marines with substance use disorders and survivors of sexual assault. In 2014, the Marine Corps identified more than 900 cases of suicide ideation — that is, Marines who had thought about suicide.

“This effort identifies Marines considering suicide, facilitates communication, and allows for coordination of care among the many professional roles supporting Marines as a team,” Whitman said. Marines can get support from the Community Counseling Program and the Marine Intercept Program — the latter launched in 2013 — to make sure Marines who are identified as being at risk for suicide receive timely care and ongoing assessments.

The C-SSRS in Action

Military and veteran institutions are adopting the Columbia Protocol as their tool for suicide risk identification. Users of the protocol include:

  • Israeli Defense Forces
  • U.S. Army Medical Command emergency departments
  • U.S. Marine Corps
  • U.S. National Guard Psychological Health Program
  • U.S. Navy, for all primary care encounters
  • More than 30 U.S. Department of Veterans Affairs hospitals across the U.S.

Military Suicide Survivor: The Columbia Protocol Is “Invaluable”

Kim Ruocco, who lost her Marine Corps husband to suicide, speaks in starkly personal terms about why and how the Columbia Protocol should be used in the military to save lives. Ruocco is also the chief external relations officer for suicide prevention and “postvention” for the Tragedy Assistance Program for Survivors (TAPS), which supports those grieving the loss of a loved one who died in the military.

“[The Columbia Protocol was a] valuable tool to ensure that necessary steps were taken to safeguard an individual or return them back home with support. It can help avoid unnecessary hospitalization or save a life. ”

VA Tennessee Valley Healthcare System