The U.S. Department of Defense (DoD) has always been concerned about suicides among service members, and the increase in suicides over the past decade has heightened that concern. Previously, DoD asked the RAND Center for Military Health Policy Research to identify best suicide prevention practices and ascertain whether the military services’ suicide prevention programs used them. The results of that research were reported inThe War Within: Preventing Suicide in the U.S. Military(Ramchand, Acosta, et al., 2011), which recommended that DoD provide formal guidance to commanders about how to respond to suicides among military personnel. This report aims to...

The U.S. Department of Defense (DoD) has been struggling with increasing rates of suicide among military personnel for the past decade. Reports from a congressionally directed task force, an Army task force, and the RAND National Defense Research Institute have all made a series of recommendations to help DoD address this issue. DoD continues to implement new programs and examine its policies in an effort to prevent more military men and women from taking their own lives.

The objective of this research was to assess DoD’s response to suicides among military personnel and to identify opportunities for enhancing DoD programs...

Suicide surveillance involves tracking and reporting information related to a suicide. A public health approach to prevention is built around surveillance because it enables “realistic problem solving, facilitates the design of prevention programs, and the ability to evaluate such programs” (Bonnie, Fulco, and Liverman, 1999). However, as discussed elsewhere (Ramchand et al., 2011; Goldsmith et al., 2002; Crosby, Ortega, and Melanson, 2011), systematic surveillance of suicide in the United States is lacking. This is largely because of variability in the degree to which suspected suicides are investigated, jurisdictional variation in the requirements for making a suicide determination, and regional differences...

Communities affected by suicide, while bereaved, may also be motivated to use the event to reinvigorate policies, procedures, and activities designed to prevent future suicides. The occurrence of a suicide may heighten community awareness of suicide, its risk factors, and its consequences. This may then provide an opportunity for leaders to garner additional support and energy for implementing suicide prevention best practices.

A previous RAND report presented a review of suicide prevention research (Ramchand et al., 2011). Much of that report and its recommendations are relevant to this study of suicide postvention. In this chapter, we review the following particularly...

Intense feelings of grief are an expected, normal response to the loss of a loved one. Grief often begins with feelings of disbelief, followed by yearning, anger, depression, and, finally, acceptance (Maciejewski et al., 2007). Disbelief, yearning, anger, and depression generally peak within the first six months following the death and then begin to decline. Acceptance generally increases over the course of the first six months and continues to increase with time (Maciejewski et al., 2007). There is no firm evidence that the loss of a loved one to suicide leads to a unique clinical form of grief (Brown et...

Ensuring that a service member who has died by suicide and his or her loved ones are both honored and respected is a multifaceted process. For the fallen, it includes how the remains of the deceased are handled and arrangements for memorial services, funeral rites, or posthumous honors received. For loss survivors, it includes both practical and social challenges related to understanding the death and learning to carry on without their loved one (Cerel, Jordan, and Duberstein, 2008). Despite the importance of these activities, the scholarly literature regarding how to ensure that those who die by suicide and their loved...

The impact of a suicide on next of kin or loss survivors is immeasurable and profound. Compared with loss survivors of other types of death, suicide loss survivors in the general population often report higher levels of shame, rejection, stigma, and blaming (Sveen and Walby, 2008). Loss survivors often feel stigma because their loved one died by suicide, and this often leads to social isolation, more difficult bereavement, and barriers to help-seeking (Cvinar, 2005; Jordan, 2001; McMenamy, Jordan, and Mitchell, 2008). More loss survivors report needing psychological services than the numbers who access it (Saarinen et al., 1999). Loss survivors...

The objectives of this study were to identify the policies and procedures in place in DoD and across the services for responding to suicide and to document the extent to which DoD programs and policies reflect state-of-the-art suicide postvention practices. Unfortunately, the evidence is so sparse in this area that it is challenging to identify the state of the art. The gold standard of scientific evidence—randomized control trials—is practically nonexistent in this area, and the bulk of the evidence derives from expert opinion. Given this shortcoming, it is surprising that we identified more than 600 unique recommendations from...