Suicidal and homicidal soldiers in deployment environments

Suicidal and homicidal soldiers present one of the most frequent and challenging scenarios for deployed mental health providers. A chart review of 425 deployed soldiers seen for mental health reasons found that 127 (nearly 30%) had considered killing themselves and 67 (nearly 16%) had considered killing someone else (not the enemy) within the past month. Of these, 75 cases were considered severe enough to require immediate intervention. Interventions included unit watch, comprehensive treatment, and medical evacuation. Of the 75 dangerous soldiers, 5 were evacuated out of theater. The rest were returned to duty. Evacuation to a hospital in the rear is often the quickest and most risk-free option but is seldom the best choice for maintaining the fighting force. This article presents several case examples and describes methods for dealing with suicidal and homicidal soldiers during deployment.