as a country we have to make a decision if we are going to protect tax breaks or make smart investments to grow our jobs and expand opportunity for every american. those are the head lines. >> there are reasons why men and women in uniform are killing themselves. a tragic less visible cost of war is the inside story. >> hello, i'm ray suarez. during america's two wars this century one problem has been

constant and resistant to efforts to combat it. service people, men and women, active people in reserve all branches of the service have been killing themselves at a high rate. the pentagon has been trying to figure outy, head people off before they end their lives, and the suicide rate has remained sub bornlstubbornly high. first, in background. >> the largest study of mental health ever conducted on u.s. military personnel revealed a startling fact. nearly half the soldiers who reported suicide attempt said their first attempt was prior to enlistment. it was believed that long repeated deployments in the recent wars were the cause. but now a first look at a huge

mental health study points to a need for better understanding the young people who sign up to fight in their nation's defense. the news comes of a ronald funded by the initial institute of mental health. one report said almost a quarter of u.s. active duty troops suffered with some form of mental illness before serving in the military. one in five had suffered panic, depression or adhd, and a tendency for anger and sunday rage. this was noted five times higher than the average rate in the civilian population. it was seen in the stie as the

most common risk factor as suicidal behavior. in the height of the wars in afghanistan and iraq betwee between 2004 and 2009 the military suicide rate more than doubled since the pentagon started tracking the number i in 2001. 569 soldiers' deaths were ruled suicide in that period. 2012 saw a peak in military suicide. a total of 349 service people taking their own lives. >> we also need to keep improving mental health services. >> reporter: as an address at a national convention president obama talked about the need for improving mental health services. >> last year i said this had to be an all hands on deck approach. not just the dod or va, but across the government, and those who are hurting know asking for

help. >> the suicide rate has fallen. the defense department reported it was down. the root root cause for army suicide remain unknown. a new star study points to risk factors which may help identify factors and focus on programs to help service members at higher risk. >> the report stands to reason and there is plenty that is counter intuitive, a closer look at suicide joining us from hall tallahassee, coauthor of

families under fire. >> were you surprised that things like deployment didn't have much impact on those who decided to end their lives? >> yes, the first surprise of the study was that the increase and the suicide rate was equally as high among people who never deployed as those who had deployed. prior to that time we just thought it was a knee-jerk reaction.

>> between male and female personnel? >> well, there are differences in suicide rates among men and women. and men have higher suicide rates than women could do. that's true in the civilian world as well as the military. the striking difference is the suicide rate of men who are deployed is roughly 50% higher than the suicide rate of male soldiers who never deployed. among women it's 300% as high among the deployed as among the never deployed. there seems to be something that is more highly associated, more distressing did deployment among women than men. this does not account for the substantial part o problem, buts quite strange. >> the numbers would tell us that many of these people had

problems before they entered the military. in fact, many even had a suicide attempt before they enlisted. why is that significant, especially given the age people are when they join. >> first of all, there is a considerable amount among college students. i joined the academy, and i've been part of some university for a long time, 40 years or so. and there has been an up tick in the number and severity of mental disorders among our students. not just at tulane university and florida state, but across the nation. >> is there something different about today's youth in general, not just those who enlist? >> there are a lot of very good things about the youth today. i could go on and on.

but no, i don't think there is much difference than in the past. we've just done a better job of analysis. i think we're better at engaging people than we've ever been. i think the quality of therapy and counseling has never been better. as a result of that we know this more, and are better at it. >> amy, the military has been trying to get a handle on this problem for years since that first up tick was noticed in the early years of the wars. has the out reach been enough? telling people in uniform to look out for things. are they getting the help and debriefing they need after that you need? >> well, there are many people in the military who are allies in support approximating suited prevention among our troops.

through is new evidence-based program and a lot of work going in the military community among non-profits and the government to try to work on this issue together and partner together. we're making head way, but we still have a ways to go. >> one of the things that is interesting in the report is about suicidal thoughts or what they call in technical terms ideation. if you're at home, and someone expresses an idea of harming themselves, is it clear who you call if you're a service man's family or service woman's family? >> there is prevention lines. there are confidential help 24 24/7. we encourage families too reach out and seek help. there is help available and help can work for many people. >> charles, when you hear amy

mention help can help many people. it's been tough for the military to put together a set of procedures a set of guidelines for people in the chain of command and for people at home to know what to look for. to prevent this before it happens. >> well, first of all warriors have come home from war forever in every culture. when they come back they're changed. they're different. and those who love them and care about them can look in their eyes and tell there is a change, there is a difference, but are they close to suicide, or are they going through a process that all invests have gone through? we just can't tell at this point in time. eventually we'll have bio markers and we can spit into a cup and analyze looking at cortisol levels, etc. but those days are not here yet,

and we're going in that direction. my heart goes out to her and everyone who works with veteran who is are close to suicide because they experience this terrible loss themselves. i know the army is doing all they can to work on this issue, and, indeed, the rate has gone down. my hope is that we would study why it's gone done as well as the reasons why it's going up. part of it is the end of the war u which is useful in terms of causing lots of distress. this is not a new finding. i know ron knows this. in the past there have been efforts to pin deployment on suicide rates, and it's not the case. those who are not deployed--in other words, it's not an issue. we can't look inside the minds of those who haven't been deployed yes and know very well that they are going to be

deployed. especially if they're enlisted. we can't rule out the shadows of deployment on those who took their lives. >> we're going to take a short break right now. when we come back we'll talk about the ways that people who join the military are different and the same from those who don't, and how it may have an impact on who tries to end their life and who doesn't. this is inside story.

consider this. the news of the day plus so much more. answers to the questions no one else will ask. >> it seems like they can't agree to anything in washington no matter what. >> welcome back is to inside story. i'm ray suarez. we're talking about the mental health in the u.s. military. new findings based on an on going collaboration between the army and the national institute of mental health showed that one in five soldiers had a common mental illness before enlisting, and i'm wondering why that

wouldn't caught, and why were they allowed to enlist? >> well, the kinds of mental disorders we're talking about are not the ones that the audience may be thinking of. if you have sits friend i can't, bipolar disorder or attempted suicide in the past, you are not allowed to enter the military. attention deficit, a common disorder. conduct disorder, juvenile delinquency. they are not more suicidal prior to entering the military.

and you might age a teenager who is a fearful kid is not going to be the type of person who will volunteer for the army. those who join the army are more confident, risk-takers, and less anxious than other people. the kinds of things that were there in abundance compared to the population to do with i want pulsesivetyimpulsivity, and ang. >> the rate of anger is five times higher among soldiers than civilians. is that a marker for pre-disposition down the road? >> well, it is. we don't think of anger being associated with suicide. we more typically think along the line of depression. but fact people who are angry at other people, who are aggressi aggressive, do have increased

rates of being angry and violent towards themselves. they are higher suicide rates. perpetrators of violent crime has higher suicide rates than other people. >> amy, are families sometimes put in. terrible situation of being retrospective, reporting things only after it's too late that they noticed along the way? >> we support families who are grieving the deaths of anyone who served in armed forces, including suicide. we do find families look back after a death an think about what might have been done differently. often they can't identify perhaps conversations that could have been different, that they wanted to help support but weren't sure how. so our families can also be a place that helps reform reas

much and reform outreach effor efforts. >> after someone takes their own life, you realize they were not themselves or the person you knew before they deployed. >> many of our families knew that their loved ones were in trouble, and knew that they needed help and support. often they were trying to support that person, but they encountered difficulty in being able to do that sometimes. so far families, i think it's how do you reconstruct that narrative in your mind, and then figure out how to better these efforts. for some, they knew that their loved ones were struggling and they were fearful. often sometimes they did not know what steps to take to help their loved ones. >> there is a whole discipline around this now. i had never seen the word traumaology until i was reading about your work, but i assume

people handle the terrible stresses of war in different ways. >> yes, first of all, i think it's an amazingly important study. ron is one of the most celebrated at this effort for a long time in lots ever areas including our area in katrina. what we're really talking about is yes we need to be careful about screening and recruitment. it's hard to screen for suicide. we obviously ask the questions, but it's very easy to say no if you want to come into the military. what makes the difference is creating these protective factors of training, education, simulation, developing an esprit di core. thyes, there are some who come

into the military wounded. i think even ron and his group talked about how to screen for those folks and try to help them out. i think that was in the first paragraph of his discussion. i don't want anyone to come to this program thinking that boy, the military is a mess. this is finest fighting force we've had ever, in the world i would say. we've asked more of them than any other war since world war ii. it is time for us to step up and do what we should be doing to protect these people and their families. even though there is monday going into this, we're very

short on this mark. >> we're going take a short break. when we come back we're going to talk more about the military's response to the challenge of suicide. what's work, what hasn't, and what could we be doing better. this is inside story.

>> welcome back to inside story. i'm ray suarez. the defense department began tracking suicides in the military back in 2001. 349 service members committed suicide in 2012, which was a record. the number fell to 245 last year. three new studies released this week are highlighting the risk factors that contribute to the problem. still with us charles figurely, director of tulane university's traumatology institute, and amy

miller, and in boston ronald kessler, the investigator for the army study to assess risk and resilience in service members. professor, that word, resilien resilience. the army has tried to build it into it's soldiers in a thought-out way, a programmatic way, and one of the findings from the survey is that those kinds of things didn't work. is that right? >> well, no, that's not right. the survey didn't look at that. but there was a recent report from the institute of medicine that was quite critical about the army's program for resiliency. it's in the early days. it's a smart idea, it seems to me, to try to develop ways of strengthening people before they are exposed to trauma. but we don't know a great deal

about how to prevent the on set of mental disorders. we're much better at treating mental disorders after they occur than at preventing them before they occur. we're in the fortunate position in an odd way, because as you noted in the beginning, ray, the rates of mental disorders are quite high in the army and many of those cases occur before the soldier joins the force. the opportunities are greatest are early detection and intervention once people get into the army. but before they get into these high-stress situations to increase resilients before the fact. >> is it fair to assume, professor kessler, that you can never drive the number down to zero, but maybe cases at the margin can be caught? >> absolutely. there is a lot that can be done to reduce the suicide rate in the army. we'll never get to zero in our lifetime. we can always help, but we can

do a big deal to put a dent. >> are things getting better? >> we find that things are improving, what risk factors to look for and how to get help. >> if we went ahead with a thorough program run of the pentagon for all branches of the service, would we be able to really put a dent in this number of really big dent in this number, or because of the age that young service people, are we just going to have to understand that there is going to be a certain amount of suicide as there is in a civilian world? >> yes, ray, thank you. yes, i definitely think that's

the case. think about this. we're always worried about school shootings. have we been that effective in preventing them? what makes a difference in school shooting prevention? it's connection with human beings, having a buddy, having a friend, someone who knows your moods, cares about you, a connection, a bonding. we know quite a built about that. the military just by booking the military does a certain amount of that. but i think we need to do more of that. the marine corp some time ago recognizing the process of post traumatic stress disorder started training marines right at boot camp and ncos, chain in command officers, being able to recognize these stressors, and help them to handle it, give them tools to manage their own stress. >> professor kessler, the medical people were very

critical of the vietnam era organization of the military. where people were shifted in and out of units not sent with their buddies from their hometown, and that was said to have had a very bad affect on both mental health and unit discipline. is it different now? and when we care wars to each other, is it different from the number of people killing themselves now from world war ii, vietnam? >> yes, the rates are higher now. traditionally as charles knows, the suicide rate goes down during times of war. the fact that there has been this increase in this particular war is really unprecedented. the ways in which one can attack this problem have to be thought of as a multitude of relatively small, focused kinds of efforts. not one particular thing. there are a number of these one

kind of thing fits all salvations that turn out to be true. 9 one about deployment we mentioned. there was concern that a session waivers reducing requirements so getting less qualified people has an affect. we found that wasn't the case. long deployments, short time between deployments. as you look at a number of these things it doesn't seem to be much going on. when we look closely at more in-depth patterns we see a number of pockets of high risk where i think there are good students for intervention and the studies hope that we can increase those pockets. if we have time we'll give you examples of a few of them. that's our best bet. not trying to look for one quick fix but this is a multi facetted problem. there are a lot of things that have to line up in the wrong way. >> well, we don't have a lot of time, not on this edition of the program, but this is something that we'll be talking about in

the future. that brings us to the and of this edition of inside story. thanks for being with us. in washington, i'm ray suarez. you >> he lay on the ground of his hometown of nogales mexico.