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Scott G Winterton, Deseret News
Leslie Zimmerman gives a small push to her son McKay during a ride with her kids Monday, April 14, 2014, at Discovery Park in Pleasant Grove. Zimmerman, a former combat medic, is struggling with contemplating suicide after serving in the Military.

Editor’s note: This is the second in a two-day look into solving the problem of suicide. Today a look at the challenges facing military veterans.

SALT LAKE CITY — As an Army combat medic, Leslie Zimmerman spent four years trying to patch up wounded comrades and friends. She was in Korea for a year and then sent to Iraq the day the war began.

She returned home in 2004, and the battles didn't stop. She said she actually wanted to go back to Iraq because she didn't know how to handle day-to-day life without the military.

"It was really, really difficult," Zimmerman said. "I wanted to go back because there I didn’t have to think about anything, because you just do what you’re trained to do, and you don’t have to worry about how you feel because you don’t have time to feel. It’s not part of the job to feel."

She said she couldn't really talk to her husband at the time about anything because she couldn't figure out where she fit into her old life. She was dealing with post-traumatic stress disorder.

Her thoughts turned to suicide.

"When I got home, it was quiet and calm, and then you have everything left over. It doesn’t just stop. You remember everything," Zimmerman said of Iraq.

Zimmerman said she was lucky to have a regular physician ask her about her mental well-being, and she was set up with a psychologist. She still goes to counseling once a week and spends time with other veterans "who get it."

But many are not so fortunate. Of the 18 Utah soldiers who died in 2013, at least 13 are confirmed suicides, said Ryan Wilcox, a former Utah state legislator.

Newly released numbers by the Pentagon reveal there were 289 suicides among active duty troops in 2013, down from 343 in 2012. The majority were in the Army, with the Pentagon reporting a 25 percent decline in the Navy (59 to 44). The Marines and Air Force were nearly the same year-over-year, dropping by three Marines and two Air Force servicemen.

The drop comes after military suicides steadily increased for about a decade, possibly because of better tracking and U.S. military involvement in the Iraq and Afghanistan wars.

A National Institute of Mental Health study of 2004 to 2009 showed the rates of deployed soldiers doubled to more than 30 suicide deaths per 100,000. The rates for non-deployed soldiers tripled to about the same rate. The average civilian rate for similar ages and demographics remained at about 19 for every 100,000.

The reported drop in suicides in 2013 indicates more is being done to help service members. But these are still personal struggles impacting American families at an alarming rate.

Leslie Zimmerman found a way through the darkness.

Lessons from Leslie

"I have kids now, so it’s not just about me," Zimmerman said. "There’s things preventing me from committing suicide, but I’m not going to lie that I don’t feel like that sometimes. Some days are better than others, but my kids and my family are enough."

Now 32 and living in Pleasant Grove, Zimmerman says she has been married to a supportive husband for six years, and they have three children, ages 6, 4 and 3.

Reaching out and finding someone to trust and then talking about it is important because it makes it "less of a reality, less plausible," she said. When she hears what she's saying, she realizes what a bad idea suicide is.

Zimmerman said coping gets easier. Working out, running and mountain biking early every morning helps her feel alive. She then spends time with her kids until they go to bed. They ride bikes and work on kindergarten homework and play games.

To people struggling in similar situations, Zimmerman said, "Just think about tomorrow because yesterday might be dark, and today might be dark, but there’s nothing saying tomorrow won’t be light."

Understanding symptoms

Dr. Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah, said the chance of having an immediate or delayed onset of PTSD is about 50/50 for those who are going to manifest severe symptoms. He said there’s a common sequence that leads to suicide: first PTSD, then substance abuse as a way to cope with trauma symptoms, and then depression because the first two affect things like mood, sleep and social relationships.

Military service members come home from a life where they have power, control, status, adrenaline rushes and a support system of people who understand.

They experience a loss similar to a civilian retiree, explained Gary Blair, suicide prevention case manager for the Veterans Affairs Salt Lake City Health Care System.

“When you come home, how to deal with going back to civilian life, that’s pretty hard … and things are a lot different when you come home, depending on how long you’ve been away,” said retired Staff Sgt. Lonnie Jorgensen of Roy, who served two consecutive nine-month tours in Iraq.

Jorgensen said he came home to an independent wife who was used to doing things on her own, so he felt “kind of worthless” and that he wasn’t needed.

“It’s hard to adapt to going back to mowing the lawn, doing the grocery shopping, and stuff like that,” Jorgensen said.

Jorgensen said he was advised to stay away from alcohol and buying guns or a motorcycle for a year, but many soldiers come home and do dangerous things for the exhilaration.

“They want to match that adrenaline rush they had when they got in that firefight or when that vehicle was blown up,” he said. “It took about a year to where my driving habits got back to normal. I still don’t trust people. I see people on an overpass and I get worried that they’re going to throw a bomb at me."

Managing stress

It's not necessarily deployment and combat stress that contribute to the high rates of suicide among military service members and veterans, Bryan said.

“Deployment in and of itself doesn’t really seem to carry much risk," Bryan said. "It’s what’s happened to them while they were deployed."

Often those deployed on peace-keeping or humanitarian missions have more mental health issues than those deployed on combat missions because of all the suffering and atrocities they see.

As with all mental health concerns, it is a matter of resiliency. Military service men and women have the same risk factors civilians have — relationship problems, financial woes, legal troubles and employment stress. Bryan said these factors are often more closely associated with mental health problems and suicide than deployment and seeing combat.

“What seems to be different is just there’s something about the military culture that serves as a barrier for seeking out health care and makes them less likely to want to talk to others about the problems that they're having," Bryan said.

The stigma surrounding suicide is one of the biggest barriers keeping people from seeking mental health help, according to Kim Myers, suicide prevention coordinator with the Utah Division of Substance Abuse and Mental Health.

"Get help," said Adam, a 34-year-old veteran from West Jordan, who asked that only his first name be used. "It’s hard to get help because you feel kind of weak, but the strength you gain from it is so much better."

Jorgensen, whose friend was one of the soldiers who died by suicide last year, said soldiers may not seek help while they’re in combat because they don’t want to be pulled from missions or leave their “battle buddies,” so they just “tough it out.” For some, asking for help is accepting defeat or letting their buddies down.

“The stigma is that you can’t be trusted if you seek help, you’re crazy, you’re weak if you seek help, … but it takes a strong person to go get help, to realize they need help,” Jorgensen said.

The military is trying to eliminate that stigma and improve suicide prevention efforts.

“It’s not weak for you to seek help. If you even feel depressed or you can’t get over something that happened and you’re feeling like you’re in a corner, seek help,” Jorgensen said.

Training and treatment

Capt. Dave Wood, a psychologist for the National Guard, said the Army goes through an annual “suicide standown,” basically a briefing on suicide prevention. Soldiers learn about risk factors, resources, hotlines, what to do and where to go.

“The idea that we really heavily rely on is the grass-roots buddy to pay attention, to act, and to get that person to safety,” Wood said.

Another training effort is the comprehensive soldier fitness program. In the Army, each company has at least one master resiliency trainer who gives monthly training on resiliency skills. The efficacy isn’t certain yet, as the program just started rolling out a few years ago, but Wood has noticed the training filtering into soldiers’ daily lives.

“There has been a little lag time from when the problem spiked and then when the response came. … I wouldn’t say that we’re there yet, but we’re working really hard,” Wood said.

Wood also said there is suicide intervention skills training, commonly called suicide first aid. He said it increases a person’s readiness and willingness to intervene.

“In most cases, if we can get in and talk to them, we can work with them and keep them safe,” Wood said. “It’s the ones that don’t talk to us that fall through the cracks.”

Military members have to be willing to talk during annual health assessments and post-deployment assessments, which are mandated right after deployment and again within six months.

"There is hope. It's absolutely curable. It's something you can live through," said Emily Hoerner with the Utah Chapter of American Foundation for Suicide Prevention.

They and their families can attend free classes provided by the National Alliance on Mental Illness in Utah and attend therapy groups at the University Neuropsychiatric Institute.

"Today is not your whole life. What’s going on today is not your whole life, no matter how bad it is, no matter how dire your situation may be," Adam said.

Adam's story

Adam said he felt great at first when he got home and everything was better just because he didn't have enemy fire coming at him anymore. But it didn't take long for things to start heading downhill.

When he came back from Iraq in 2004 after five years of Army service, he didn't have much support. He said the resources soldiers have now were essentially nonexistent at the time.

His PTSD symptoms were aggravated by the stress of moving to Iowa, starting a new job, being away from his two kids and receiving divorce papers in the mail. Adam could sleep only about two hours a night because he was waking up in cold sweats after having nightmares that were "exponentially worse" than what he actually saw in Iraq.

One horrendous night, he said, he "cracked." He woke up after passing out and drove to the VA hopsital and received help.

The solution: He realized he had something new to fight for.

"I fought for my country. I fought for what I believed was right, and I basically changed my game plan," Adam said. "I fought for my kids and I still fight for my kids. I found a new war."

Adam said he is remarried to a woman who has been his "rock," and he puts his focus on his four children — 11, 10, 6 and 6 months.

Helping others

War is people being as sane as they can in an insane situation, said Blair of the VA, who called it a “sacred privilege” to help veterans and others in the emergency room or through the crisis line.

A host of factors can contribute to a person considering suicide: substance abuse, health issues, a history of abuse, loneliness, relationship issues, worthlessness, mood instability, anger, anxiety, homelessness, unemployment, legal issues, financial stress and poor support.

When these things happen, people's emotions and feelings are depressed. They are in a “dark place” and don’t see other options.

“Generally the only emotion that can come out is anger, and, usually, it’s anger toward themselves or others,” Blair said. “And so, because of limited options somebody has, they really do want somebody to step in and help take charge of their life. People who attempt suicide or complete suicide generally do not want to die. Suicide is a permanent solution to a problem that’s generally short-term.”

Individuals and their loved ones can look for warning signs: people thinking about hurting themselves, preoccupation with death, and self-destructive or risky behavior, particularly if it involves weapons, drugs or alcohol.

Factors that can help prevent suicide include positive social support, spirituality, family responsibility, life satisfaction, engagement in treatment, positive coping skills and children in the home.

“Always ask the question,” Blair said. “It’s never wrong to ask if they’re suicidal. It won’t put that idea in their head.”

Blair also said eliminating secrecy and attending the VA are both big protective factors.

Said Adam: "You’re always going to have a war inside, but that doesn’t mean you have to fight your battles alone."

How to get help

Veterans and their family members needing help can call the Veterans Crisis Line at 1-800-273-82551-800-273-8255 and press 1, send a text to 838255 or chat online at veteranscrisisline.net.

Anyone struggling with substance abuse, mental illness or any crisis can call a county crisis hotline, the Statewide CrisisLine at 801-587-3000 and the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). People in crisis can also call 911 or go to an emergency room.

Email: [email protected], Twitter: Madeleine6