Army's Life-or-Death Drama
To Combat Suicides, Service Introduces Interactive Video

By Ann Scott Tyson
Washington Post Staff Writer
Wednesday, October 8, 2008

Alarmed by a record rate of suicide in its ranks, the Army yesterday unveiled a unique prevention tool -- an interactive video to be mandatory viewing Army-wide -- in which soldiers will play the role of an anguished infantryman and make virtual choices that lead the character to get help or, in the worst case, shoot himself in the head.

"This is you: Specialist Kyle Norton," a male narrator begins, putting soldiers in the boots of a 19-year-old Midwesterner after a bomb-clearing mission in Iraq.

The video, titled "Beyond the Front," leads the viewer through a detailed drama in which Norton is hit by relationship troubles, financial problems and scrapes with the law -- what Army research shows are major events that precipitate suicide. Norton is blindsided by an e-mail from his fiancee, who has become pregnant by another man. He is devastated further when one of his best friends is killed in an ambush.

Questions pop onto the screen at key moments, prompting the viewer to decide whether to get help -- by opening up with buddies, Norton's sergeant or a chaplain. Depending on the choices, Norton edges toward recovery or sinks deeper into suicidal thoughts. The goal is to immerse the viewer into Norton's life in a way that makes preventive lessons stick, say Army officials and the video's creators.

The video is one of several initiatives launched by the Army to try to stem the suicide rate among active-duty soldiers. That rate increased from 12.4 per 100,000 in 2003, when the Iraq war started, to 18.1 per 100,000 last year.

This year, 93 active-duty soldiers killed themselves through the end of August, the latest data show. A third of those cases are under investigation by the Armed Forces Medical Examiner's Office. In all of 2007, 115 soldiers committed suicide. Suicide attempts by soldiers have also increased since 2003.

If the trend continues, the death rate this year is likely to exceed that of a demographically similar segment of the U.S. population -- 19.5 per 100,000, Stephens said -- which has not happened since the Vietnam War.

Army officials will begin distributing 14,000 copies of the video by December, making it mandatory instruction for all active, National Guard and Reserve units.

"I don't know of anything that's as sophisticated and innovative as this product," said Col. Elspeth Ritchie, a psychiatrist at the Army Surgeon General's Office.

Outside medical experts say the video is unusually realistic but warn there are risks of using such a product without first gauging its effectiveness. Army experts and the creators of the program acknowledge they have no evidence the video will have the intended impact.

"We are hoping it will make a difference," Ritchie said. She said the product was tested in focus groups of soldiers and will be further assessed upon implementation, but added that it is "always very hard to measure the success of preventative interventions."

Each time a soldier takes his or her life, "we have failed," Lt. Gen. David P. Valcourt, deputy commander of the Army's Training and Doctrine Command, said in an interview last month. Valcourt is a member of the Army generals' steering committee on suicide prevention. Yesterday, he said two soldiers killed themselves the weekend after the interview.

Lengthy deployments to Iraq and Afghanistan are contributing to the rise in suicides by straining relationships and causing mental health problems, said Abdoulaye Bah, director of the Center for Suicide Prevention, Research and Studies at Lincoln University in Jefferson City, Mo. The center, the Army Research Laboratory and the company Will Interactive in Potomac collaborated to create "Beyond the Front."

"Repeated deployments have really taken a toll in the Army; for some reason, they didn't want to accept that early on, but now they have," Bah said.

"One of the leading causes of suicidal ideation in the Army has been the breakdown of relationships," he said. "The husband is gone, the wife is gone . . . and the relationship doesn't work anymore."

"Beyond the Front" is unique in that it requires soldiers to take the vantage point not of a helper but of someone who is suicidal. "I know at least 10 soldiers who could be" the jilted Norton, Valcourt said, recalling that when he first showed his staff the video, one worker pulled him aside and told him, "Sir, that was me."

"It sure beats the heck out of a PowerPoint or the first sergeant standing in front of the formation and saying, 'I don't want anyone to hurt themselves this weekend,' " he said.

Lanny Berman, executive director of the American Association of Suicidology, who viewed part of the video, said that "it's obviously done in a much more realistic fashion" than previous interactive prevention efforts. Nevertheless, he warned that it is risky to widely distribute such a program without scientific evaluation to determine its impact on a suicidal person. "Some media presentations about suicide can increase the likelihood of suicidal behavior, so there is a potential danger," he said.

Another limitation is the paucity of evaluation of community-based suicide-prevention programs such as those underway in the Army, said Alexander Crosby, an epidemiologist with the division of violence prevention at the Centers for Disease Control and Prevention. An exception, he said, was a 1990s program by the Air Force that succeeded in cutting suicide rates in the service by more than 50 percent, in part by reducing the stigma around seeking help.

"Beyond the Front," filmed using actors and some soldiers at Army bases at Aberdeen, Md., and Fort Polk, La., aims to encourage soldiers to recognize the slide into a suicidal state and to get help.

The goal is "to allow people to play it out before they live it out," said Sharon Sloane, president of Will Interactive.

Chris Stezin, senior scriptwriter for the project, drew upon interviews with enlisted soldiers and officers for his portrait of Norton, who is young, white and male -- the demographic most at risk for suicide.

"That is the soldier I want to reach, where the internal voice goes, 'You know, I could just end this.' Hopefully it will flick a switch . . . and they will say, 'No, it's not quite right,' " Stezin said.

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