Suicide is a leading cause of death in the United States. The suicide rate for active military is higher than the general population, while that for veterans is much higher. Although suicide is not unique to the military population, some considerations are particular to this population. Cultural sensitivity and understanding are necessary to provide effective counseling services to the military and veteran population. We spoke with Dr. Rebekah Cole, Director of Research in the Military and Emergency Medicine Department at the Uniformed Services University, about suicide in this population and what counselors should know. 

What makes suicidality among the military population a distinct issue? 

Service members and their families face unique lifestyle stressors such as extended deployments, frequent moves, and potentially dangerous work environments. In addition, within the military, emphasis is placed on high achievement and performance. Bravery is celebrated, and struggling with mental health may be perceived as a weakness. Thus, service members might be hesitant to seek out mental health support.  

It is commonly understood that there is a particular stigma against seeking mental health treatment in the military population. How does this affect suicidality? 

Service members and their families may be hesitant to seek out mental health support since it may be seen as a weakness and going against the military values of strength, courage, and commitment. Service members may try to hide mental health struggles for fear it could hinder their reputation, performance reviews, and chances of rank promotion. This mindset may trickle down to families, who may feel this same pressure to appear brave and strong and so be hesitant to seek out support as well. Overall, leaving mental health issues unaddressed may lead to an increase in suicide within the military population.  

Are there suicide risk factors that are more common among the military population? 

Service members may have easy access to firearms. Service members may also suffer from PTSD or moral injury as a result of operational deployments. As far as military spouses, when the service member deploys, spouses may find themselves alone for long periods of time without any family support nearby, leaving them without support or anyone who will encourage them to seek out help. 

Are spouses often overlooked regarding suicide in the military population? Are there stressors or risk factors that are particular to military spouses? 

Military spouse suicide was recently revealed to be a prominent and increasing phenomenon. Military spouses often take on some of the same core values as service members, feeling pressure to “stay strong and carry on.” In addition, a service member may be hesitant to encourage their spouse to seek mental health services because they fear it may impact their own reputation and performance rating. What’s more, military spouses may find it difficult to find mental health support when they move to a new location (e.g., finding a provider with availability, one that they “mesh” with, and who accepts Tricare). They may also become isolated when moving to a new duty station without any friends or family nearby, potentially leading to depression and suicide ideation.  

You indicated some reasons members of the military population might be more likely to conceal suicidal ideation. How can counselors better overcome this barrier? 

Counselors should clearly explain confidentiality to military clients, who may be worried that their commander may find out they are seeking mental health support. The counseling profession can also partner with military leaders, taking a systemic approach to promoting and normalizing mental health services and support.  

Counselors should be direct when working with military clients and screening them for suicide ideation and should create a safe space for them to share openly and honestly. Counselors should be familiar with the mental health resources provided by the military such as Fleet and Family Services, Military One Source, Tricare (the military’s health care program), and Military Treatment Facilities (where active-duty service members receive health care) in order to facilitate wraparound support when needed.  

Do counselors need specialized training to be culturally competent to assist this population? 

Don’t shy away if you’re new to military culture—showing curiosity about the military lifestyle goes a long way! And it will mean a lot to your military clients if you express appreciation for the challenges that they face and the sacrifices they make in their daily lives.  

If you want to learn more about military culture, volunteering at military bases and with organizations such as the USO can help you become more familiar with the military language and lifestyle. Finding ways to meet the unique needs of military families—such as helping to facilitate childcare for deployed spouses or facilitating support groups for new military spouses to the area—can go a long way in building trust with this community.  

Are there particular resources you recommend for counselors who want to learn more about this issue? 

The Center for Deployed Psychology at the Uniformed Services University has some excellent resources for mental health care professionals for understanding suicide in the military. The Defense Suicide Prevention Office also provides updated data, information, and resources to counselors who work with the military population. Military One Source has excellent resources for understanding military culture that are easy to read and process.  

*The opinions and assertions expressed herein are those of the interviewee and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences or the Department of Defense. 

Rebekah Cole is an Associate Professor and Director of Research in the Military and Emergency Medicine Department at the Uniformed Services University (USU), where she conducts Department of Defense–funded research on the impact of mindfulness training on service members’ performance in the operational environment. Dr. Cole holds a PhD in counseling and an MEd in school counseling. She is a Licensed Professional Counselor and a National Certified Counselor. Prior to her faculty appointment at USU, Dr. Cole served as the inaugural Program Director of the MSE School Counseling Program at Arkansas State University, where she developed the MSE School Counseling Curriculum. Throughout her career, Dr. Cole has published more than 50 peer-reviewed journal articles, including best practices for counselors’ work with service members and their families and national studies examining military spouse suicide. For the past 10 years, Dr. Cole has worked closely with military spouses to navigate mental health challenges in her work as a Licensed Professional Counselor and as a volunteer ombudsman with the United States Navy in Okinawa, Japan. As an active-duty Navy spouse for 15 years, Dr. Cole has lived in Europe, Asia, and across the United States. She currently lives with her husband and two children in Arlington, Virginia.