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Wednesday, September 14, 2016

Time for Moral Courage- We Must Deal With Suicides in Armed Forces: The Quint

My opinion piece for The Quint on the ‘World Suicide Prevention Day’:

Ironically, one of the strongest organisations of our nation, our pride- the Indian Army, is downright timid in certain respects. I say so since this sturdy and powerful establishment has not had the moral courage to admit its deteriorating physical and psychological profile over the years, perhaps in order to maintain a certain kind of image in the public, but for what? And with what consequence?

The inherent stress and strain of military life is universally recognized and we have discussed it here at The Quint before. India is no different. The rigours of military duty coupled with distance from one’s family takes a toll on the health of troops, thereby exploding the myth that defence personnel enjoy a better health profile than civilians. Closer home, studies show that military personnel die a decade earlier than civilian employees but then such studies are kept dormant and are not put in the spotlight as they should be. But it seems that the focus is more on brushing this aside and delinking it from military service and blaming ‘domestic reasons’ rather than admitting that stress and strain of service is taking a toll on the health of uniformed personnel and also leading to a rising rate of Post Traumatic Stress Disorder (PTSD) and suicides. Of course, this is intertwined with even the rising rate and aggravation of physical diseases since the thread of stress and pressures of military service commonly runs across.

It goes without saying that the Indian society has failed its soldiers. When a soldier is away on military duty, his or her mind is not at ease. The mind wanders. The mind is where the family is, the mind is where the local goon is troubling the parents, the mind is where the children are struggling for admissions, the mind is where the property is usurped by the neighbour but the administration or police do not give a damn. But then all these are ‘domestic reasons’ for the Army, not realizing that the stress which emanates is a direct result of military service since the person cannot be there to handle domestic commitments like his civilian peers. To put it bluntly, these problems would not have emerged had the person not been in military service- a situation which even the Defence Minister of the country understands when he writes to State Chief Ministers elaborating that “frustration arising out of inability to resolve domestic issues is a major contributing factor to stress”. Still however, at times the Army’s medical boards or even finance and accounts officers sitting in their air conditioned offices declare them ‘domestic reasons’ thereby  washing the system’s hands off and also denying such soldiers their disability benefits, a grim reality discussed in detail in Paragraph 2.2.1 of the Raksha Mantri’s Committee of Experts of which this author too was a member. The British were better since even in the 1930s, they considered behavioural and psychiatric disorders in the Indian uniformed forces, including suicides under certain circumstances linked with service conditions, a stipulation which exists in the rule book even today but is very conveniently ignored by the system.

Whatever be the rate of suicide and such problems in the Army as per our perception- high or low, it’s a problem the existence of which needs to be accepted. The situation cannot be salvaged merely by steps such as meditation and yoga and liberalized leave policy or by training General Duty Soldiers in counselling. The situation can only be addressed if there is ample confidence in the men and women in uniform that the civil administration would be responsive back home when the family needs them, the problem would only be controlled if within the system there is reasonable catharsis and vent to the grievances of soldiers through more interaction between seniors and juniors rather than the hackneyed ‘statutory’ and ‘non statutory’ complaints which are seldom decided in time or with due application of mind. The problem would only be sufficiently taken care of when it is admitted that this indeed is an issue that stares us in the face.

Other modern Armies are doing much better and taking it head on. Soldiers are trained to recognize symptoms such as emotional outbursts, avoidance of interaction and other unusual behaviour. It is being imbibed that seeking help is not a sign of weakness. The US Army has embedded more than 60 behavioural health teams in operational military establishments consisting of psychologists, psychiatrists and social workers.

In our country, while the Army incorrectly thinks that their regular soldiers imparted training on counselling or psychiatrists of the Army Medical Corps can handle it, it is the Indo Tibetan Police Force (ITBP) which has shown the way and taken the apt progressive step by recruiting Education and Stress Counsellors, a specialized cadre at lower ranks specifically meant for the purpose of handling stress. Moreover, the job of identifying and addressing these issues is that of Clinical Psychologists and professional Counsellors, not of Psychiatrists. So if a person repeatedly ‘wanders out’ of the unit in a dazed state or displays irritable or erratic behaviour with his peers or seniors or suddenly starts indulging in binge drinking, the answer to it may not be a ham-handed ‘red ink entry’ or disciplinary action or throwing him out of service, but adequate care to understand the root cause.

To sum up, the following steps are the need of the day in order to contain the concerns of the rising behavioural and psychiatric disorders in the uniformed services:

A.      Inculcating the moral courage of admitting the deteriorating health profile due to rising stress and strain in the forces which primarily emanates from a highly regimented lifestyle and time away from the family coupled with the demanding nature of the job. It must be realised that admitting the problem is not a sign of weakness.

B.      Ensuring that such disorders are not blamed just upon ‘domestic reasons’ and the organisation takes full responsibility since mostly there is a direct or indirect link with military service. Moreover, transgressions by soldiers due to behavioural disorders or irregular behavioural patterns should not be dealt with by way of punishments but through counselling or medical care.

C.      The States should be made to understand the gravity of the situation and district administrations be made aware of the fallout of not addressing complaints and representations of soldiers.

D.     Redressal of grievances should be realistic in the Armed Forces and not merely a formality through the system of formal complaints that are not decided in time or which are not satisfactorily addressed. There should be more interaction between senior and junior ranks so as to allow catharsis and vent to ease troops’ pent up emotions. Electronic forums introduced by the Indian Air Force and the Army’s Western Command are good examples of encouraging such interaction.

E.      Focus should be on counselling and clinical psychology and not on psychiatry alone. Not all such functions can be performed by psychiatrists who are medical professionals and not trained to handle these issues. Professional Counsellors at Non Commissioned Officer (NCO) level must be inducted on lines of the ITBP in all uniformed services and embedded in operational units or formations.

We must realise that the tough looking soldier standing guard for us is as much human as any other person on the street. He or she is extraordinary in bravery but very ordinary in other human attributes- has the same family, the same feelings, the same emotions and the same problems as all of us and of course the same flesh and blood. It would therefore be a travesty if the response of the society or the establishment is not commensurate with his or her impeccable service. 


karunakaran a ex havildar said...

dear major sir,

every article of you is having some new and valuable things to be followed and adopted in army. even civil authorities are having some significant guidelines to deal their employees for creating conducive atmosphere in the work culture, junior and senior proximity brotherly affection must be there to some extent in resolving domestic problem. punishment is the last resort not the first one, once awarded soldier become so ferocious he tends to commit more crimes firstly officers must understand what to do

Cdr. Nitin Deshpande said...

Unfortunately, anyone diagnosed with any psychiatric disorder will immediately get thrown out from the career ladder. That is why soldiers do not approach psychiatrists even when under great stress or depression. In many cases senior officers have raised AFMS 10 on officers who were even little bit eccentric or stubborn or were found to be under stress. This immediately lables them Pscho patients and that will be end of his career.

Mohan said...

Defence personnel pay a heavy price for not being available to their children during their formative years. Most of the bonding between parents and children takes place during the very initial stages of growth of the child as a result of physical touch. That is the time many fathers are not available to their children. various activities in Peace stations have encroached upon private space so much so that personnel prefer a field station rather than a peace station because of various commitments.
If a comparative study is undertaken I believe that due to lack of continuous quality time there would be many non-tangible losses which cannot be made up.

Unknown said...

We have lost our way somewhere. We as officers have to look if we are sticking to our own laid down Trg objectives and means during peace tenure. We are all busy but is it causing any value addition if not then it causes demotivation, which affects our action. Do we treat our troops with due respect in peace time or we misuse them in the name of discipline using them as sahayaks, brooming stn roads /garden(where his own children are playing) away from his unit. Also no family accn or only for giving for half his tenure, Officers leading poorly by making the troops run when they walk in groups during PT period in the morning.All these add to low morale and stress. Or have I misunderstood completely!??

Manohar said...

According to the National Institute of Mental Health, Major Depressive Disorder is the leading cause of disability in the US (among ages 15-44) and it is estimated that about 6.7% of the US adult population is affected by Major Depressive Disorder in a given year. While depression may not always commonly be associated with the military population, in the 2011 Survey of Health Related Behaviors among Active Duty Military Personnel (2013), 9.6% of Service Members reported high levels of depression. Even though firm figures are not public in our Armed Forces, the figures may not be quite different from the US statistics. Fortunately, depression is a treatable disorder. Cognitive Behavioral Therapy (CBT) is an empirically-validated psychotherapy that is recommended as a first-line treatment for depression in the VA/DoD Clinical Practice Guideline for Management of Depressive Disorder (2009). CBT is a structured, short-term, present-oriented approach to psychotherapy that helps patients modify unhelpful patterns of thinking and behavior in order to resolve current problems. All commanders at every level must be educated in recognizing this disorder and give psychotherapy at unit level (unit gurdwaras and unit mandirs under the religious teachers) and the field hospitals. Normally if somebody is sent to hospital on form AFMS 10, it is considered as a (social) stigma on the individual and the unit which the individual and the unit commanders must overcome.