To reduce suicides Fairbanks Army base must improve quality of life, public health survey says

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FAIRBANKS, Alaska (KTVF) A report has been released by a behavioral health team that was sent to Fort Wainwright to examine the situation on post.

A behavioral health epidemiological consultation, or EPICON, was requested after Congressman Don Young sent a letter to the Surgeon General of the U.S. Army and Commanding General, U.S. Army Medical Command requesting a team of medical professionals to be sent to Fort Wainwright to examine the situation on the ground in relation to the reported suicides. (Sara Tewksbury/KTVF)

A behavioral health epidemiological consultation, or EPICON, was requested after Congressman Don Young sent a letter to the Surgeon General of the U.S. Army and Commanding General, U.S. Army Medical Command requesting a team of medical professionals to be sent to Fort Wainwright to examine the situation on the ground in relation to the reported suicides.

Although this report was not initially made public, a copy of the executive summary was shared with us and because the findings are relevant to the community who has been aware of the deaths on Fort Wainwright, we are sharing some of the findings from the report.

Since spring of 2018, there have been several deaths of military members in the Interior of Alaska. The community and family members have been trying to get answers as to why it seems that a higher number of Soldiers and Airmen are taking their own lives. We looked at deaths that were not attributed to a training incident, car accident, or other known cause.

Fort Wainwright, has seen nine deaths of this manner since May of 2018.

May 2018 – 23-year-old, manner of death: Confirmed suicide by Army Criminal Investigation Command

September 2018 – 22-year-old, manner of death: Confirmed suicide by Army Criminal Investigation Command

October 2018 – 21-year-old, manner of death: still under investigation, not determined whether it was accidental or intentional

January 2019 – 25-year-old, manner of death: still under investigation, not determined whether it was accidental or intentional

January 2019 –24-year-old, serious initial incident report describes manner of death consistent with suicide

February 2019 – 33-year-old, manner of death: Confirmed suicide by Army Criminal Investigation Command

June 2019 – 20-year-old, manner of death: still under investigation, not determined whether it was accidental or intentional

August 2019 – 22-year-old, manner of death: Suicide, based on Fairbanks Police Department Incident/Investigation report

September 2019 – 33-year-old, manner of death: still under investigation

Since most of the cases are still under investigation, those are not included in the number of deaths by suicide. The EPICON report mentions 11 suicides that were identified from January 2014 to March 2019 and of those 11 suicides, the report mentions that five of the deaths occurred between May of 2018 to March of 2019.

Through our reporting, there has been an inconsistency in the number of suicides that Fort Wainwright and U.S. Army Alaska Officials have been releasing.

On January 25, 2019, we received information through a Freedom of Information Act, of the number of suicides on Fort Wainwright per year since 2001. From 2001-2015, there was from 0-2 deaths by suicide a year. In 2016, there were 3, 2017, there were 0, 2018, there were 3, and as of January 25th, they reported one death by suicide in 2019.

In the executive summary of the ‘Assessment of Behavioral and Social Health Outcomes at Fort Wainwright, Alaska, March-September 2019’, the results of the survey are outlined.

The report outlines that the EPICON team reviewed clinical records, analyzed more than 800 Serious Incident Reports, conducted 45 focus groups with Soldiers and 1 focus group with family members, interviewed 30 key leader groups and 4 command teams, analyzed population-level BH care encounters, surveyed more than 4,000 Soldiers, and reviewed 43 U.S. Army Alaska, Garrison, and U.S. Army Medical Department Activity Command policies.

The report states “to date, findings from the [behvaioral health team] have not pinpointed definitive reasons for why Soldiers die by suicide. However, they can identify broad risk and protective factors associated with adverse behavioral and social health outcomes.”

One of the topics Soldiers talked about in the survey was perceived barriers to accessing behavioral healthcare.

“The most common reasons for not seeking [behavioral health] care were related to stigma. Soldiers felt that leaders would treat them differently (22%), that they would be seen as weak (21%), that seeking [behavioral health] care would harm their career (21%), and that coworkers would have less confidence in them (20%). Other reasons included receiving time off for the visit (21%) and worrying that the visit would not remain confidential (18%),” stated in the report.

Roughly one-third (34%) of Soldiers reported poor sleep quality in the week prior to taking the survey and one-third (34%) of Soldiers reported that in the past year they were worried food would run out before they got money to buy more, or the food they bought did not last and they did not have money to get more.

The findings and recommendations were presented in range from short-term to long-term. We have included a full list of recommendations at the bottom of this article.

The report concludes that the problems Soldiers at Fort Wainwright face are consistent with previous EPICONs, but that the additional challenges of the arctic environment may compound problems, creating additional stress.

Senator Scott Kawasaki represents the district that Fort Wainwright is in, as well as serving on the Joint Armed Services Committee, and said his office has been working on this issue for the past year and are relieved that they were able to review the executive summary of the report.

“The executive summary was a little bit vague as far as some of the causes and some of the reasons but certainly there is an issue at Wainwright and within Alaska that needs to be addressed when it comes to suicides on our military bases,” said Kawasaki.

He says they are still waiting on the full report but hope it is made available to the public.

“A document of this nature, which discusses Soldiers and some of the critical issues about why suicide is being committed on our bases is important for the public,” said Kawasaki.

With the perceived increase in deaths on Fort Wainwright, many family members of Soldiers currently stationed at Fort Wainwright have been communicating with each other to see if there is anything they can do. One mother said she is in Facebook groups with other parents where they discuss news of Fort Wainwright, including the deaths by suicide that have been occurring on post.

“I didn’t really know anything about Fort Wainwright before my son was sent there, and then ya know joining these (Facebook) groups, with other moms, parents, whatever, and then I see these suicides and the suicide rates and the number of people just from since he’s been there, and I was shocked,” said Adkins.

Kawasaki says there are some basic recommendations laid out in the executive summary that should happen immediately.

“Very basic things like ensuring R&R, making sure folks have access to healthcare, mental health issues, those types of things, making sure that folks have something as simple as blind curtains so that when they’re here during the summer in 24 hour sunlight, that they don’t have to be disturbed by the sunlight,” said Kawasaki.

“I get it, they’re Soldiers, I get that, however they’ve got to recognize when somebody is really asking for help, and without making them feel badly about asking for help,” said Adkins.

“I certainly hope that they look at the report as a way to sort of stop the trend that we’ve seen and that’s increased suicide within our military bases,” said Kawasaki.

U.S. Army Alaska Media Relations Chief, John Pennell, says that the results of the EPICON report show them that they were correct for requesting a team to come to Fort Wainwright, “to look into quality of life issues or what we can do moving forward to make things better for Soldiers and families who are stationed at Fort Wainwright and across Alaska as well.”

Pennell says that Commanding General Major General Peter Andrysiak held a town hall with Soldiers and their families in October to talk about quality of life issues on base and they will be holding another town hall on November 5th at 6 p.m. with more details to come.

After trying to set up an interview with Andrysiak for months, we were not able to get an interview. However, Pennell continued to comment saying that they were already working on implementing some of the recommendations from the EPICON report.

“A lot of the recommendations are items that we can address immediately, whether it be something as simple as making sure that we offer Soldiers more time with their families, we can put black out curtains in the barracks and in housing so that the long summer daylight doesn’t keep people from sleeping. Sleeping disorders were identified as one of the major factors for Soldiers and their families,” said Pennell.

He said they are also working to have 24 hour access for one of the gymnasiums, and looking at other changes they can make to address the recommendations from the EPICON report.

UPDATE:

Comments from Alaska Congressional Delegation on EPICON report:

From Senator Dan Sullivan's Office:

"Senator Sullivan is saddened by the lives lost and grieves with the families and friends who are suffering from their loss. Senator Sullivan and his team have received a copy of the EPICON report – are reviewing it – and continue to be very engaged with senior Army leadership and the Army’s leadership in Alaska on finding solutions for the challenges at Ft Wainwright, including those identified in the report."

Congressman Don Young's Spokesperson Zack Brown:

"Congressman Young and his staff have been briefed by the EPICON Team in conjunction with U.S. Army Alaska leadership, and sadly the initial findings are not surprising. There will be no quick fix for this ongoing issue that is causing pain for too many families. Congress needs to be working with the Army to ensure that long-term strategies are designed and put in place to help combat the tragedy of military suicides. Congressman Young is grateful for Senator Sullivan’s continued partnership on this issue and stands ready to work with the Alaska Delegation and Army leadership to turn the tide in the fight against a problem affecting far too many service members."

EPICON Report Recommendations:

Quick-wins (completed within 30 days)

Findings (Suicidal behavior):

From January 2014 through March 2019, 11 suicides were identified. Observed findings were consistent with suicide cases in previous EPICONs. Soldiers who died by suicide had indications of multiple risk factors, these included pain, sleep, and relationship issues. Eight cases had documented pain issues. Ten of the 11 cases had interactions with the medical system during their period of service in the Army,
Whereas only one case appeared to have had little interface beyond required physicals.


  • In the month prior to taking the online survey, 10.8% of FWA Soldiers reported suicidal ideation. Soldiers who reported greater resilience or social support were less likely to report past-month suicidal ideation; whereas, those with severe sleep problems, depression, loneliness, anxiety, post-traumatic stress disorder, or hazardous drinking were more likely to report past-month suicidal ideation.

  • Soldiers identified isolation, stigma, limited resources, poor coping skills, alcohol use, and poor quality of life at FWA as factors they perceived as contributing to suicidal behavior.

Recommendation:


  • Encourage early access to helping services, and optimize the use of existing processes for data collection and sharing to facilitate communication after a suicidal behavior event.

    • Leverage existing systems and structures to continue and improve engagement with the installation, embedded, and unit-organic BH services to improve early use of available resources, facilitate cross-talk and coordination with medical and nonmedical installation and unit-organic assets, and reduce identified barriers to care.

    • Request quarterly requests for information from BSHOP to monitor Department of Defense Suicide Event Reports [DoDSERs] for suicide attempts and suicidal ideations.

    • Consult with APHC Health Promotion and Wellness (HPW) and Clinical Public Health and Epidemiology Directorates to review and build upon the current Value of Life Standing Operating Procedure.



Findings (Performance Triad: Sleep, Activity, and Nutrition):


  • Roughly one-third (34%) of Soldiers reported poor sleep quality in the week prior to taking the survey.

  • Among Soldiers who reported poor sleep quality, 41% cited too much light getting into the barracks as a contributor.

  • Soldiers across all ranks and Family members repeatedly advocated for 24-hour gym access, a larger gym or additional gyms, and higher quality gym equipment.

  • Soldiers expressed concerns with lack of easy access to high quality, nutritious, and affordable food options.

  • One-third (34%) of Soldiers reported that in the past year they were worried food would run out before they got money to buy more, or the food they bought did not last and they did not have money to get more.

Recommendation:


  • Address elements of the P3 related to sleep, activity, and nutrition:



  • Sleep

    • Request funds for sleep masks, “black out” curtains, and light boxes (“happy lights”) to address extreme daylight and darkness.

    • Use APHC/BSHOP sleep infographic for education outreach as part of the medical threat briefing at in-processing.

    • Consider a consultation with the Walter Reed Army Institute of Research Sleeping Working Group to address unique environmental and population-level sleep concerns.



  • Activity

    • Request resources to expand fitness facility capacity and hours of operation.



  • Nutrition

    1. Consult with APHC HPW to implement strategies to address the food environment by serving as a pilot location for the Military Nutrition Environment Assessment Tool [mNEAT] 3.0 tool.



Finding (Alcohol and substance use):


  • This was the first BSHOP BH EPICON in which driving under the influence was the most prevalent type of SIR.

Recommendation:


  • Consider ways to prevent driving under the influence of drugs and alcohol.

    • Increase the occurrence of safety checkpoints.

    • Offer enticing volunteer incentives (e.g. 3-day pass after specific time) for the Soldiers Against Drunk Driving program.



Short-term:

These findings included limited staffing for behavioral health positions, limited resources and activities on post for Soldiers and family members, and an issue with work life balance with the Soldiers.

When it came to work life balance, Soldiers reported that their families were the most important source of support for them, but that the work life imbalance strained these relationships.

According to the report, nearly a third of Soldiers reported struggling to make ends meet.

Recommendations in the short-term category are to be completed in 30-45 days.

The recommendations include:


  • Fill and sustain mission-critical positions (e.g., BH clinicians, Health Educator, Family Advocacy Program Specialist, and Health Promotion Specialist).

  • Employ targeted marketing of MWR and BOSS programs in a way that promotes awareness of tiered pricing (i.e., sliding scale fees by rank) for recreational events.

  • Reevaluate feasibility of providing an on post shuttle for Soldiers and Family members to access resources.

  • Accelerate the opening of a facility for child-friendly events as soon as possible to address concerns about access for Family members.

  • Evaluate Arctic Warrior Standards for leader time, Family time, and pay-day activities to address leader training, interpersonal relationships, and financial readiness.

Mid-term:

The findings in this category included how the isolation of being in an arctic environment can be stressful for Soldiers and families who are stationed at Fort Wainwright. Referencing the increased cost of living, drastic daylight changes, and the fact that for over half of the Soldiers surveyed, this was their first duty station, so they not only had to adjust to being in the Army but living in the Arctic.

Another finding was that the barracks are aging, overcrowded, vandalized, and that there are delays in filing work orders which all contribute to a “self-described stressful living environment and poor quality of life for Soldiers.”

Recommendations for the mid-term category are to be completed in 60-90 days, which include:


  • Coordinate focus groups with Soldiers and Families to develop on-boarding resources that can be disseminated prior to arrival at FWA and that addresses the uniqueness of FWA.

  • Enforce CG Policy #20 (Barracks Utilization and Command Visits to Residences) and evaluate implementation of health and welfare inspections.

Long-term:

Recommendations in the long-term category are to be completed in 6 months or more. The findings in this category touched on finances, stressors and leader development.

In the finances area, Soldiers reported that financial conditions were worse after moving to Fort Wainwright than before. Soldiers also referenced equipment used in training commonly being inoperable due to extreme cold.

For stressors, sleep disorders affect 11.4% of Soldiers on Fort Wainwright, and hazardous drinking was reported by 22% of Soldiers.
When looking at Serious Incident Reports, alcohol or drugs were contributing factors in most of these incidents on Fort Wainwright, and domestic violence incidents were the third most prevalent type of Serious Incident Report.

One of the topics Soldiers talked about in the survey was perceived barriers to accessing behavioral healthcare.

“The most common reasons for not seeking BH care were related to stigma. Soldiers felt that leaders would treat them differently (22%), that they would be seen as weak (21%), that seeking BH care would harm their career (21%), and that coworkers would have less confidence in them (20%). Other reasons included receiving time off for the visit (21%) and worrying that the visit would not remain confidential (18%),” stated in the report.

When looking at stressors, the analyses looks at how chronic pain was identified in Soldiers who have died by suicide.

“Histories of chronic pain were documented in 8 of the 11 Soldiers who died by suicide while stationed at FWA. Some notes indicated that chronic pain caused issues in their work environment and with their fellow Soldiers. For example, Soldiers did not want to show the level of pain they were experiencing because they feared appearing weak in front of leadership or subordinates.”

Recommendations:


  • Leadership request assistance from higher to mitigate the financial strain unique to Alaska.

  • Develop and implement a comprehensive education campaign plan to address stressors commonly associated with behavioral and social outcomes.

  • Sleep hygiene

  • Pain management care and services

  • Alcohol use and misuse

  • Help-seeking for BH and relationship problems

  • Stigma regarding the use of BH care and services

  • Financial readiness

  • Prioritize comprehensive leader development and training to support the mission command philosophy and promote individual and unit resiliency.

  • Develop and prioritize a company-grade leader course to address common behavioral and social health stressors associated with stationing at FWA.

  • Prepare personnel for successful deployment of the Commander's Risk Reduction Dashboard.

  • Request that FWA be a priority site for deployment of a suicide prevention leadership tool after validation

Suicide Prevention Resources:

24/7 Crisis Hotline: National Suicide Prevention Lifeline Network

http://www.suicidepreventionlifeline.org/

1-800-273-TALK (8255) (Veterans, press 1)

Crisis Text Line

Text TALK to 741-741 to text with a trained crisis counselor from the Crisis Text Line for free, 24/7

Veterans Crisis Line

Send a text to 838255

Vets4Warriors

SAMHSA Treatment Referral Hotline (Substance Abuse)

1-800-662-HELP (4357)

RAINN National Sexual Assault Hotline

1-800-656-HOPE (4673)

National Teen Dating Abuse Helpline

1-866-331-9474

Also visit your:


  • Primary care provider

  • Local psychiatric hospital

  • Local walk-in clinic

  • Local emergency department

  • Local urgent care center

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