Suicide killed more American troops last year than combat in Afghanistan, and that is likely to be the case again this year.
Historically, the suicide rate in the military has hovered around half the civilian rate. But in 2004, that changed: The rate doubled, and now it's on track to overtake the civilian rate.
The causes and remedies of the suicide epidemic are complicated, but one Army base in Texas has bucked the trend: At Fort Bliss, the suicide rate actually went down last year. In fact, it's declined consistently over the past three years: down to five suicides in 2012 from 12 in 2010.
"It was kind of a no-brainer," says Maj. Gen. Dana Pittard, who last month finished three years as the top commander at Fort Bliss. "Our focus was getting our soldiers to [get] help."
"In 10 years, only one case [of suicide at Fort Bliss] that we know of ... took place when a soldier was in treatment," says Pittard.
Pittard has battled to overcome the military's macho culture that considers reaching for help a sign of weakness. He mandated that all troops arriving at Fort Bliss take a two-day suicide awareness and prevention course that was different from the training used by the rest of the Army.
The program, which uses a more interactive approach, including role-playing, stresses action and intervention by peers to help troubled soldiers. But asking if someone feels suicidal is just the first step.
"That is the hard part. Ask the questions," says Storey Smith, a social worker, who teaches suicide prevention at Fort Bliss.
"But then the next thing that happens is if the answer is, 'Yes,' what do I do?" she says. "Equally important, if the answer is 'No,' is he really OK?"
A Brother's Helplessness
Army Staff Sgt. Kevin Allen grew up in a military family. His older brother Jason joined the Air Force, and then a couple years later, in 2001, Kevin joined the Army. The two brothers — best friends — still talked on the phone constantly.
"We took Verizon to the cleaner when they offered us unlimited minutes," Kevin says. "I'd drain my phone and then take my wife's phone. We would talk nonstop."
During Kevin's two Iraq deployments, the brothers lost the ability to stay in such constant contact.
But in 2009, things were looking up. Jason was out of the Air Force and living near their parents in Jackson, Ohio. Kevin was home from Iraq and stationed just a six-hour drive away in Maryland.
That spring, they weren't talking as much as Kevin had hoped. Then a strange phone call coincided with a day of Army training — a dull PowerPoint course on suicide awareness.
"I have to be honest, I couldn't have cared less about the training. And nobody in the room could," Kevin says. "We sat through it every single year."
But that evening, Jason called for the first time in weeks. The subject of the conversation was mundane, but the tone was off.
"He's talking about the cost of inkjet printers. Going on and on, typical conversation. Something just struck me. It was his demeanor; I couldn't really enunciate just what it was," Kevin says. "Then it hit me: I think he's suicidal."
Kevin got permission from his superior and then drove through the night to Ohio. The whole way he was grappling with a question.
"What if he said, 'Yes, I'm going to kill myself' but then refused any other services. Was I prepared to call the sheriff on him?" Kevin says.
It took all weekend. Kevin bought a case of beer and took his brother out to burn a brush pile for their dad. They sat by the fire, drinking.
"I finally turned to him and said, 'Jason, we need to talk. What's going on?' He looked at me and I knew that he knew what I was going to say. But he just got up, and walked away. And that was the end of my nerve," says Kevin. "It was like every bit of the fears that I had that he was going to reject me for this, that confirmed them."
The next morning, the brothers said goodbye in the rain. Kevin Allen drove back to Maryland. Jason Allen killed himself a week later.
Kevin says he's played the moment over endlessly in his head, thinking about what he could have done differently. Three years later he arrived at Fort Bliss. He dreaded the idea of another suicide prevention course. But it wasn't the same old PowerPoint presentation. Soldiers role-play through the awkward process of asking questions and taking action with someone contemplating suicide.
"I truly believe that had I had that training, that I can't guarantee that my brother would be alive, but I know for a fact that that night sitting out by a bonfire, every bit of my actions would have been different," Kevin says.
A Colleague's Intervention
The training also teaches that anyone can be at risk, which highlights a surprising fact: Half of the suicides in the military are troops who never saw war. While PTSD and brain injuries from combat are contributing factors, it remains stubbornly hard to predict who will fall victim.
"Most people with any given risk factor never attempt [suicide]," says the National Institute of Mental Health's Michael Schoenbaum, who studies military suicide. "Suicide is not like food poisoning, where you find out what is in the salad bar and you go remove the tuna salad."
Other factors are the same as in the civilian world: relationships, drugs and alcohol, or money problems.
"It just got overwhelming, to the point where I didn't know what to do," says a Fort Bliss soldier who asked to use only his nickname, "Sgt. D."
His commanding officer says Sgt. D is a great soldier; he never showed any signs he was in trouble. But this April, with bills stacking up and a relentless workload, Sgt. D saw no solution.
He was at home on the patio; his wife was out, his two young kids inside. He started thinking about how to kill himself. If a gun had been handy, Sgt. D says, he might well have used it.
Instead, he called a soldier in his unit, Spc. Katherine Kline.
"I was in the field and ... I got a phone call from him," Kline says. "It was pretty alarming."
"I opened up to her and burst out in tears, telling her I don't feel like being here anymore," Sgt. D says.
They'd both had the suicide prevention training, so perhaps on some level Sgt. D chose to call someone who would listen, and do something.
Kline got her commanding officer; after calling the MPs, they headed to Sgt. D's house.
"After it happened and we got there, and I saw that he was OK, I was like, what if he wasn't going to do it, like I just made this big mess for nothing," Kline says. "But at the same time, I was thinking, what if I never see him again. When he hugged me all the fears went away, and I was like, 'OK I did the right thing.' "
Sgt. D is still on active duty and is receiving counseling. With the support of his commander, he's considering an Army program that helps enlisted men train to become officers.
Around the country, Army bases are implementing aspects of Fort Bliss' multipronged approach. The much larger bureaucracy of the Pentagon is moving a bit more slowly, with a framework for suicide prevention due at the end of this year.
ROBERT SIEGEL, HOST:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
MELISSA BLOCK, HOST:
And I'm Melissa Block. This week on the program, we're talking about the problem of suicide in the military. Yesterday, we heard the story of one Marine's life and death. Today, we're going to examine how lives might be saved. Experts don't really understand what drives people to commit suicide, and that means there's no easy solution. But one Army base - Fort Bliss in El Paso, Texas - has made suicide prevention a mission.
NPR's Quil Lawrence visited the base and has a story about this agonizing question: How do you intervene, if you think someone may take his own life?
QUIL LAWRENCE, BYLINE: Staff Sgt. Kevin Allen grew up in a military family. He joined the Army; his brother, Jason, joined the Air Force.
STAFF SGT. KEVIN ALLEN: He and I were best friends.
LAWRENCE: I spoke with Kevin, now stationed at Fort Bliss.
ALLEN: We took Verizon to the cleaner, when they offered us unlimited phone calls back and forth. And - I mean, we would just talk nonstop. We were just very, very close.
LAWRENCE: Kevin deployed twice to Iraq. Jason never saw combat. But it was Jason who had struggled with depression over the years. They couldn't talk so much when Kevin deployed. But when he came back from Iraq, they had a chance to be close again. Jason had left the Air Force and was living near their parents in Ohio. Kevin was stationed just six hours away.
It was March 2009; it was a Friday. Kevin had spent all day in a boring Army course on suicide.
ALLEN: I have to be honest, I couldn't have cared less about that training. And nobody in the room could. We sat through it every single year.
LAWRENCE: That evening, his brother calls. Jason hadn't called in weeks. They talked about nothing important - inkjet printers, actually - but something was off.
ALLEN: Something just struck me. I couldn't really enunciate exactly what it was. And then it kind of hit me. I said, I think that he's suicidal.
LAWRENCE: Staff Sgt. Kevin Allen called his superior, explained a little; and then drove through the night, to Ohio. He wanted to intervene, but he wasn't completely sure he knew how.
ALLEN: What if he told me, yes, I'm going to kill myself? Was I prepared to call the sheriff on him, and what would that do to my relationship? And so I'm scared. And so that Saturday, I went and bought - I call a suitcase; a 30-pack of Milwaukee's Best, which is kind of an old tradition from when we were much younger. And we went out. And my dad has a farm in Ohio there, and he had a brush pile that needed burned.
Drug a bench over; we were sitting there with beer. And he's sitting right next to me - right to my left. And the whole time, I'm trying to work up the nerve to simply ask this question. And finally, I just turned to him and I said, Jason, we need to talk. What's going on? And he looked at me, and I knew that he knew what I was going to say.
But he just got up and walked away. That was the end of my nerve. It was like every bit of the fears that I had that he was going to reject me for this - yes, that confirmed them.
LAWRENCE: Next morning, the brothers said goodbye in the rain. Kevin Allen drove off. Jason Allen killed himself eight days later. Kevin has replayed that moment by the bonfire a million times in his head, wishing he'd known what to say.
STOREY SMITH: That is the hard part. Ask the question.
LAWRENCE: Storey Smith is a social worker who teaches suicide prevention at Fort Bliss.
SMITH: But then the next thing that happens is, if the answer is yes, what do I do? Equally important, if the answer is no, is he really OK?
LAWRENCE: The base claims the lowest suicide rate in the Army. Smith puts that down to the intensive training here. Everyone takes a two-day course, even Kevin Allen. Two years after his brother took his own life, Staff Sgt. Allen arrived at Fort Bliss. He was not keen on a two-day-long discussion of suicide. But this isn't the famously dull Army course. It's a program called Assist, produced by a private company.
Soldiers role-play. Billboards all over the base encourage everyone to nudge troubled soldiers into treatment. The bottom line: When in doubt, intervene. The training also teaches that anyone can be at risk. Half of the suicides in the military are troops who never saw war. Often, the issue is a relationship or money.
SGT. D: Should I go to these loan sharks? Should I - you know, what should I do? Bills just start stacking up.
LAWRENCE: That's another soldier at Fort Bliss. He goes by Sgt. D. He asked to use just his nickname because of the stigma around mental health issues.
SGT. D: It just got overwhelming, to the point where, you know, I didn't know what to do.
LAWRENCE: His commanding officer says Sgt. D is a great soldier, never showed any signs he was in trouble. But Sgt. D was bottling up a lot of frustration. By this April, it was too much for him. He was at home on the patio, his wife was out, his two young kids inside. He started thinking about how to kill himself.
SGT. D: I didn't have a gun. I didn't want to bleed out and have my kids see it.
LAWRENCE: If a gun had been handy, Sgt. D says he might well have used it. Instead, he called a soldier in his unit, Spc. Katherine Kline.
SPC. KATHERINE KLINE: I was in the field, and I got a phone call from him. It was pretty alarming.
SGT. D: And then, you know, I just opened up to her, just burst out in tears and just started telling her, you know, I don't feel like being here anymore.
KLINE: After we hung up - and I didn't know what to do, so I was like, OK, it's not right. Something has to happen right now.
LAWRENCE: They both had the training, so Sgt. D maybe knew he was calling someone who would listen and do something. Spc. Kline did do something. She got her commanding officer. They called the MPs and made for Sgt. D's house. Then, she called him back.
SGT. D: And she was crying. And she was like, I'm sorry. I was like, what are you sorry for? And the two MPs cars pull, and the ambulance pulls up. And the fire truck pulls up.
KLINE: After it happened and we got there, and I seen that he was OK, I was like, what if he wasn't going to do it? Like, so I just made this big mess for nothing. But then, at the same time, I was sitting there thinking, like, what if I never see him again? To me, it was worth it. At first, I was like man, what have I done? I'm so sorry Sgt. D. Like, I didn't mean to embarrass you or anything. But now and even whenever he hugged me, all the fears went away. And I was like OK, I did the right thing.
LAWRENCE: Sgt. D is getting help. He's still on the job. Other bases throughout the military are looking at how to teach the skills that prevent suicide, skills Staff Sgt. Kevin Allen only wishes he'd had four years ago sitting next to his brother, Jason.
ALLEN: I truly believe that had I had that training - that I can't guarantee my brother would be alive, but I know for a fact that that night sitting out by a bonfire, every bit of my actions would have been different.
LAWRENCE: Kevin Allen says worst case, he would have intervened, and his brother would have hated him for a few years. Those years would be over by now, Allen says, but his best friend would still be around.
Quil Lawrence, NPR News. Transcript provided by NPR, Copyright NPR.