At Fort Hood and Armywide, some Soldiers are waging a war outside of the theaters in Iraq and Afghanistan. These Soldiers are battling depression, stress, medical and relationship problems, all of which are the leading causes of suicide.

It is a battle Soldiers do not have to lose because there is a force ready to help in the form of unit command, social workers, medical and psychological professionals, helping agencies and — likely the first line of defense – the Soldier’s own battle buddies.

That’s the concept behind the Army’s Suicide Prevention Week’s theme this year “Shoulder-to-Shoulder – no Soldier stands alone.” Suicide Prevention Week is Sept. 7-13 and the theme conveys the idea that Soldiers are stronger together, especially when times are tough.

Soldiers relate best to those with shared experiences and battle buddies count on each other in combat as well as in garrison. Recurrent deployments, stress increases, prolonged periods of separation and horrific conditions in theater are difficult to explain to Family members and civilian friends.

For that reason, Soldiers continue to lean on and expect help from their peers. To be prepared to help, Soldiers and leaders need to recognize depression and know risk factors and warning signs of suicide.

“Be cognizant of what’s going on with your battle buddy,” Lt. Col. Ben Phillips, chief, Behavioral Health at Carl R. Darnall Army Medical Center, said. “They’re counting on us. We can’t just wash it under the table.” Phillips urges Soldiers to listen to each other and pay attention to any red flags or disturbing trends, but cautions that professionals should perform treatment.

“Realize you’re not a mental health expert,” Phillips said. He suggested Soldiers “lend a soft ear,” and then escort the depressed Soldier for treatment. “Ensure they’re safe. Safety is the primary key,” he said.

“Do not leave them alone.” Since the beginning of the Global War on Terrorism, the Army has lost the equivalent of an entire battalion task force, more than 580 Soldiers, according to Sergeant Major of the Army Kenneth Preston.

Suicide is the fourth leading manner of death for Soldiers, behind hostile fire, accidents and illness, Preston stated in the Army Suicide Prevention Program guide. The Army has seen a recent increase in suicides.

In 2007, there was a 21 percent increase over the previous year and, although 2008 figures are not complete, it appears the trend is continuing. Soldiers operate in austere conditions and must perform tasks and see things no one ever should. They shoulder the hopes, expectations and freedoms of all Americans and others around the world.

They are warriors who volunteer to do what others cannot. With all they can and do handle, Soldiers sometimes find themselves experiencing relationship problems, depression, severe, prolonged,or perceived unmanageable stress, serious medical problems and significant loss.

“We all feel anxious and overwhelmed from time-to-time,” Lt. Gen. Rick Lynch, III Corps and Fort Hood commander said in his Aug. 7 (Fort Hood Sentinel) column. “However, suicide and suicidal behavior is never a normal response to stress. If you are suicidal or think someone you know is suicidal, help is available.”

From chaplains to medical services and hotlines and Web sites, resources and services are available to help. Seeking help is no longer as taboo or stigmatized as it was in the past. As the war continues, the stigma attached to depression is removed, Phillips said.

“Soldiers are seeing their buddies seek and receive treatment,” Phillips said. In most cases, confidentiality is so high the Soldier’s command is not even notified a Soldier sought mental health help. “Typically, the Soldier’s command is not notified, unless there is a safety or deployment issue,” Phillips said.

For Soldiers who choose not to talk to friends or prefer another avenue of one-on-one help, battalion chaplains are another venue for assistance and guidance. “We’re reaching out,” Chaplain (Lt. Col.) Marvin Luckie, chief, Department of Ministry and Pastoral Care at Carl R. Darnall Army Medical Center, said.

Luckie knows the stresses faced by Soldiers and said a chaplain can act as a sounding board in a non-threatening way. Armed with educational materials, resources and experience, chaplains can offer advice, direction or simply an understanding ear.

The discussions do not have to be denominational or even spiritual. Luckie said recurrent deployments and, for new Soldiers, adjusting to Army life can be trying experiences for anyone. Like everyone else, Soldiers sometimes need a break. “(Soldiers) too need to be recharged,” Luckie said.

Fort Hood has an active Behavioral Health Department at CRDAMC to help Soldiers recharge and manage depression. The good news is Soldiers are seeking help. Phillips said his department sees a lot of walk-ins and referrals. The medical center offers in-patient and out-patient mental health services to Soldiers.

Currently, there are eight beds in the in-patient unit, but Phillips said that number is expected to increase to 12 beds in November. In addition, the Resilience and Restoration Center provides outpatient mental health services to Soldiers.

Warrior Combat Stress Reset Program, a two-week intensive outpatient program that was developed at Fort Hood, uses various intensive therapies and operates on a continuous cycle providing mental health care for eight to ten Soldiers.

Soldiers in the program are assigned to that program for the two-week period. Hotlines and Web sites are available as well and many use Military One Source to gain immediate access to counseling.

The key is that Soldiers are able to talk when they need to, Phillips said. Whatever the method, Soldiers experiencing risk factors for suicide need immediate help. It is not a battle anyone needs to fight alone because there is an Army standing shoulder-to-shoulder to help.

Hundreds of Fort Drum Soldiers received training last week on one aspect of war that does not always take precedence: the battle of the mind.

Retired 1st Sgt. Michael Rinehart, training specialist from the U.S. Army Medical Department Center and School, came from Fort Sam Houston, Texas, to offer Battlemind Warrior Resiliency Training. The training was integrated into the advanced individual training for health care specialists and AMEDD Officer Basic Leader Course / Basic Officer Leader Course curriculum in July, and a mobile training team teaches it to Soldiers throughout the Army.

Rinehart offered two-hour courses for those certified in combat life saving and four-hour courses for medics, to teach them how to help themselves and others when they are dealing with stresses of military life. The medics’ portion was a “train the trainer” segment, to give them valuable information to take back and teach fellow medics and others.

“Warriors go to other warriors—someone they trust—when they have a problem, and you need to know how to deal with it,” Rinehart told Soldiers Friday. “And for some of you, they are already coming to you.”

Rinehart talked about how some people are more able to cope than others, and even mild stressors can set people off.

“You can get (stress) from standing in line at Wal-Mart,” he said.

He told participants they should make it their responsibility to help fellow Soldiers be mentally prepared for combat or other military deployments.

“You can’t keep sending bodies where you haven’t trained their minds to go. If you send them before their minds are ready, there’s a price and you’re going to pay it. Treat them now, or you’ll treat them later,” Rinehart said. “Preparing yourself and your Family is extremely important, too.

“Medics, especially, do everything they can for others—stay up late for their Soldiers, take care of their Soldiers—but they don’t take care of themselves,” he added. “Don’t forget about the ones who don’t necessarily have battle buddies looking out for them, like the commander and the doc.”

Rinehart also talked about those who already are suffering effects of deployments.

“The warriors need to understand that their thoughts and emotions are common, they’re fine, they’re predictable,” he said. “We need to help diminish the stigma and barriers to seeking behavioral health care if people know they’re struggling. Some people don’t go because they think others will look down on them, think they’re incompetent or crazy or weak, but they need to know that what they’re going through is normal.”

Rinehart said it is important for Soldiers to find a way to tell their Families what they have been through.

“It’s important to be able to redevelop the same cohesive bonds that you developed with your fellow warriors with the people who should be the most important in your life—your Family,” he said. “You have to be able to discuss your experiences in a way you’re comfortable telling it, and above all, you have a right to be proud of your service.”

Rinehart added that medics should take it seriously that some Soldiers really need help.

“You should ensure early identification of an at-risk warrior,” he said. “You’re no longer the medic friend, you’re the medic authority. If you know someone who’s acting like they’re still downrange, but they’re sitting at home, there’s a problem.”

He talked about the TAIL light effect. Warriors need help getting help, and this acronym gives some pointers.

T: Tell them you are concerned; listen to their story without getting in the way, and then tell them what you are seeing and hearing so they can hear it back.

A: All are impacted by war, and it could be any Soldier, so watch out for each other during deployment and at home.

I: Insist they see someone, and have names and numbers of resources available, like a chaplain or behavioral health professionals. Explain that you have been taught enough to know when to be worried, but not enough to treat them. Remind them they would do the same for you, as a good battle buddy.

L: Look for ways to help, whether it is offering to go with them, make the phone call for them, drive them, get directions for them. Check back with them often, letting them know you are there to help and that you are not going to let this drop.

Another thing Rinehart emphasized is how medics deal with the death of a Soldier.

“You can’t think you’re not worthy to do your job because a Soldier died,” he said. “People die when you do everything right. You have to be genuine about that and honest with yourself and others.”

MAJ Matthew Barry, chief of psychiatric services, Behavioral Health, USA MEDDAC, facilitated bringing the training to Fort Drum, because he sees people all the time who suffer from common stress and emotional issues stemming from the high operational tempo here.

“We want people to know that it is most common for Soldiers to turn to their peers, but here is what to do if it is over your head,” Barry said. “We need to break down the stigma that holds people back from getting help. No one is being held back from promotion—there is no adverse effect to getting help.

“The good news is, what they are going through is completely treatable,” he added. “People feel like they can’t be helped, but if they get the right treatment and stay away from avoidance techniques, like drinking and drugging, it is treatable.”