A young National Guardsman walks into our clinic for an initial assessment. He can barely hold eye contact as he tells his clinician about how depressed and anxious he has been. With a bit more conversation, he reveals that he has been thinking about killing himself and, just last week, took extra medication with the goal of ending his life. He has been thinking about a different plan to try “next time” and isn’t sure he can keep himself safe. Unfortunately, this is all too common a scene.
According to the Department of Defense Suicide Event Report (DoDSER) CY 2015 “The suicide rates for the Active Component and the Reserve Component … were consistent with what would be expected if the military had the same age and sex composition as the U.S. general population. The rate of suicide for the National Guard was higher than expected, compared to the general population, after adjusting for age and sex.” Indeed, although Guard and Reserves make up only 38% of our military’s manpower (21.5% Guard and 16.8% Reserves), the 2015 DoDSER report sited surprisingly high rates of suicide among reserve forces, with 27 deaths by suicide per 100,000 in the National Guard and 25/100,000 in the Reserves, as compared to 20 deaths by suicide per 100,000 among active duty service members.
What’s more is that this higher risk for suicide is compounded with the fact that many National Guard Members are not entitled to active duty or VA health care benefits, and may have minimal income, and/or no insurance at all.
A 2010 Westat survey tells us that while the majority of Guard and Reserve Members are able to maintain civilian employment in addition to their part-time military service, a solid minority (16.5%) are unemployed and looking for work and only about half (52%) report annual household incomes of $60,000 or more, even though on average most are married (61.3%) and or have dependent children (56.9%). Approximately 15% reported that they did not have health insurance. Moreover, those who are not activated or recently deactivated are not automatically covered by healthcare insurance. While reserve forces are eligible for Tricare Reserve Select, many cannot afford even these reduced premiums and/or identify challenges in locating accepting providers.
As providers, it is critical to understand the unique challenges that members of the reserve forces may face, especially in light of the increased risk of suicide. National Guard and Reserve members, face the challenges and stressors of military and civilian lives, working to balance careers, fitness and readiness, family obligations, and more without the supportive infrastructure most active duty members experience. In particular, Guard members may also live some distance from their nearest VA or Active Duty base, and, as noted, most are not entitled to VA or active duty health benefits even if they do have access. To make matters more confusing, Guardsmen, unlike Reservists, are under the primary control of their state, which makes navigating their benefits and infrastructure even more complex. Indeed, many members of the Guard identify that they do not know who to contact if they are put “on profile” – i.e., a limited duty profile subsequent to a positive behavioral health screening, etc. – or incur a medical bill related to their service (e.g., are injured during a training weekend).
Fortunately, as part of the Cohen Veterans Network, we are able to provide free behavioral health care to members of the National Guard, help them navigate their military and civilian benefits to obtain insurance, identify work opportunities, and help to reduce other barriers to care and wellness.
By Leah Blain, PhD
Steven A. Cohen Military Family Clinic at The University of Pennsylvania