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Military suicides have increased by as much as 20% this year compared to the same period in 2019, and some incidents of violent behavior have spiked as service members struggle under COVID-19, war-zone deployments, national disasters and civil unrest.While the data is incomplete and causes of suicide are complex, Army and Air Force officials say they believe the pandemic is adding stress to an already strained force.And senior Army leaders — who say they’ve seen about a 30% jump in active duty suicides so far this year — told The Associated Press that they are looking at shortening combat deployments. Such a move would be part of a broader effort to make the wellbeing of soldiers and their families the Army’s top priority, overtaking combat readiness and weapons modernization.The Pentagon refused to provide 2020 data or discuss the issue, but Army officials said discussions in Defense Department briefings indicate there has been up to a 20% jump in overall military suicides this year. The numbers vary by service. The active Army’s 30% spike — from 88 last year to 114 this year — pushes the total up because it’s the largest service. The Army Guard is up about 10%, going from 78 last year to 86 this year. The Navy total is believed to be lower this year.Army leaders say they can’t directly pin the increase on the virus, but the timing coincides.“I can’t say scientifically, but what I can say is - I can read a chart and a graph, and the numbers have gone up in behavioral health related issues,” Army Secretary Ryan McCarthy said in an AP interview.Pointing to increases in Army suicides, murders and other violent behavior, he added, “We cannot say definitively it is because of COVID. But there is a direct correlation from when COVID started, the numbers actually went up.”Preliminary data for the first three months of 2020 show an overall dip in military suicides across the active duty and reserves, compared to the same time last year. Those early numbers, fueled by declines in Navy and Air Force deaths, gave hope to military leaders who have long struggled to cut suicide rates. But in the spring, the numbers ticked up.“COVID adds stress,” said Gen. Charles Brown, the Air Force chief, in public remarks. “From a suicide perspective, we are on a path to be as bad as last year. And that’s not just an Air Force problem, this is a national problem because COVID adds some additional stressors – a fear of the unknown for certain folks.”The active duty Air Force and reserves had 98 suicides as of Sept. 15, unchanged from the same period last year. But last year was the worst in three decades for active duty Air Force suicides. Officials had hoped the decline early in the year would continue.Navy and Marine officials refused to discuss the subject.Civilian suicide rates have risen in recent years, but 2020 data isn’t available, so it’s difficult to compare with the military. A Pentagon report on 2018 suicides said the military rate was roughly equivalent to that of the U.S. general population, after adjusting for the fact that the military is more heavily male and younger than the civilian population. The 2018 rate for active duty military was 24.8 per 100,000, while the overall civilian rate for that year was 14.2, but the rate for younger civilian men ranged from 22.7 to 27.7 per 100,000, according to the National Institute of Mental Health.James Helis, director of the Army’s resilience programs, said virus-related isolation, financial disruptions, remote schooling and loss of child care all happening almost overnight has strained troops and families.“We know that the measures we took to mitigate and prevent the spread of COVID could amplify some of the factors that could lead to suicide,” said Helis, who attended department briefings on suicide data.Army leaders also said troops have been under pressure for nearly two decades of war. Those deployments, compounded by the virus, hurricane and wildfire response and civil unrest missions, have taken a toll.Soldiers’ 10-month deployments have been stretched to 11 months because of the two-week coronavirus quarantines at the beginning and end. McCarthy said the Army is considering shortening deployments.Gen. James McConville, Army chief of staff, said there’s new attention to giving service members “the time that they need to come back together and recover.”“We were very focused on readiness four years ago because we had some readiness challenges, and we did a great job. The force is very, very ready now. But I think it’s time now to focus on people,” he told the AP.McConville and Army Sgt. Maj. Michael Grinston said units have begun “stand-up” days, where commanders focus on bringing people together, making sure they connect with each other and their families and ensuring they have strong values in how they treat each other.The isolation is also taking a toll on veterans, particularly the wounded.Sergio Alfaro, who served in the Army for 4 1/2 years, said fears associated with the virus intensified his PTSD and suicidal thoughts.“It’s definitely something that’s made things a bit more chaotic, trying to plan for the future, do things together,” said Alfaro, who deployed near Baghdad in 2003, facing daily mortar rounds, including one that killed his commander. “It’s almost like adding more trash on the heap.”While he once feared that strangers passing by might hurt him, now he fears people may have COVID and not show symptoms. Others in support groups, he said, “are just sick of living this way, worried about what’s coming over the next hill, what next horrible thing are we going to be confronted with.”Roger Brooks, a senior mental health specialist at the Wounded Warrior Project, said veterans are reporting increased suicidal symptoms and anxiety. Between April and the end of August, the group saw a 48% jump in referrals to mental health providers and a 10% increase in mental health calls and virtual support sessions, compared to the previous five months.Brooks said there’s anecdotal evidence that the pandemic has made wounded warriors like amputees feel more isolated, unable to connect as well with support groups. He said injured vets have seen disruptions in medical visits for pain management and other treatments.Within the Army, Helis said the virus has forced an increase in telehealth calls and online visits with mental health providers. That has generated some positive results, such as fewer missed appointments.“And we also think there was a reduction in the stigma of seeking behavioral health because you can do it from the privacy of your home,” he said.Military leaders also are encouraging troops to keep a closer eye on their buddies and ensure that those who need help get it.That message was conveyed in a remarkable public statement this month by Gen. John Hyten, vice chairman of the Joint Chiefs of Staff. He said he sought help while heading U.S. Strategic Command from 2016 to 2019. He didn’t reveal details but said he saw a psychiatrist – a rare public admission by a senior officer.“I felt like I needed to get some help,” Hyten said in a video message. “I felt like I needed to talk to somebody.” He encouraged others to do the same, if needed, without fear of hurting their career._____ Need help? Call the National Suicide Prevention Lifeline (1-800-273-8255) Military veterans press 1. Individuals can also go to: https://suicidepreventionlifeline.org/talk-to-someone-now and veterans can go to woundedwarriorproject.org or call the project’s resource center at: 888-997-2586. 7565

Mass shootings and acts of terrorism may dominate headlines, but it's the homicides and, to a lesser extent, the suicides that happen out of the spotlight that make up the bulk of firearm-related deaths around the world, according to a study published Tuesday in the journal JAMA. More gun deaths happened outside of war than in it during the years researchers examined (1990 through 2016) in 195 countries and territories.Worldwide, an estimated 251,000 people died by gun in 2016. In 1990, there were 209,000 firearm-related deaths. Accounting for population growth, that's an annualized rate decrease of 0.9 percent.Gun deaths are predominantly concentrated in six countries that make up less than 10 percent of the world's population. The United States, Brazil, Mexico, Colombia, Venezuela and Guatemala together account for more than half of the gun-related deaths worldwide.In 2016, the majority of global firearm deaths -- an estimated 64 percent -- were homicides. Suicides accounted for 27 percent of the gun deaths. A small fraction, about 9 percent of gun deaths, were accidental.If you were to look on a map, the highest numbers of gun-related homicides are concentrated in a belt that stretches from Mexico through the Caribbean to Brazil. Many of these homicides involve drug cartels, the authors suggest, and there's a problem with organized crime and the illegal gun trade.El Salvador saw the greatest concentration of gun-related homicides in 2016, with 38.9 per 100,000 people. By comparison, Singapore, the country that had the fewest, had 0.1 gun-related homicides per 100,000."The sheer magnitude of these deaths and the range in firearm-related deaths is extraordinary," said the study's senior author, Chris Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.The most vulnerable demographic to gun violence was men between 20 and 24 years old. Men were also the biggest perpetrators of gun violence.Suicide-by-gun rates declined globally between 1990 and 2016. Some countries, though, struggled with this public health crisis. In 2016, Greenland had the highest number of firearm suicides, with 22 deaths per 100,000 people. The US had the second-highest number, with 6.4 deaths per 100,000 in 2016."The US really has quite marked rates around suicide," Murray said. "That was a surprise to me."For perspective, the United States has 4.3 percent of the world's population, but suicide by gun there represented 35.3 percent of all firearm suicides in the world in 2016. By comparison, there were twice as many firearm suicides as gun-related homicides in 2016 in the US.Americans also own more guns per capita than residents of any other country, with about four in 10 Americans saying they either own a gun or live in a home with guns, according to a 2017 Pew Center study.Americans have been killing themselves more with guns over the past decade, but homicide numbers have been relatively flat. The US ranks 30th in the world for total number of homicides, according to the study.The highest increase in gun-related suicide rates in this time period was in Jamaica, and Singapore had the fewest gun-related suicide deaths. These numbers, Murray said, are an important reminder about how widespread this public health problem is.There is no one single trend behind gun violence. Drugs, alcohol, a lack of mental health services and domestic violence are often to blame, as is poverty, the study suggests."Places with high rates of firearm mortality that are getting worse tend to be places with weak government institutions, especially in the criminal justice system or social upheaval," Daniel Webster, who has written extensively about gun violence as director of the Johns Hopkins Center for Gun Policy and Research, wrote in an email. Other things that stood out from these numbers, he said, is that while the "measures aren't great," he said, "there is a connection: more guns, more gun-related deaths."Webster, who was not involved in the new research, added that the general downward trend in firearm mortality is something that stands out because "we tend to think of our current rates of gun violence as the worst ever, but there has been great progress" toward stemming some of this violence.Laws that seem to limit gun violence include ones that strengthen background checks and require permits for ownership, the study authors said. More restrictions on guns in Brazil and South Africa seem to suggest a link between a reduced access to gun ownership and a lower number of gun-related suicides and homicides. 4601

Many of them had known each other for years. That's no surprise in a small town like Sutherland Springs, Texas, where lives intersect daily on the street, at school and in the church.Twenty-six of those lives ended Sunday when Devin Kelley walked into the First Baptist Church of Sutherland Springs with an assault rifle.Law enforcement has not released the identities of any of the people killed, but family members have come forward with details and photos of their slain loved ones.Here's what we know so far about the people who died: 546

Millions of out-of-work Americans are being surprised by new information. The 0 a week they were relying on receiving through the end of July is set to end a week earlier than they expected.“That is one week less of payments than families get. That is huge. That is the difference between being able to make a car payment, make your rent, put food on the table,” said Heidi Sheirholz.Sheirholz is a former chief economist with the Department of Labor and the current senior economist at the Economic Policy Institute and explained why the CARES Act supplemental is ending so soon.“What it says in the legislation essentially is that it ends on July 31 and we all thought, you know, the end of July, but when you look at the very specific language, what it says is that the last payment will be on or before July 31,” said Sheirholz.Basically, July 31 is a Friday. State unemployment systems end their week on the weekend and pay only full weeks. So, the last full week for a payout will be on July 26. Most states had listed July 31 as the final payment on their respective state’s unemployment website and have scrambled in recent weeks to clarify and adjust the date."It’s just going to create enormous hardship,” she added.Many people will more suddenly go from about ,000 a week in total unemployment benefits, to only whatever their states’ normal unemployment benefits are, which on average is about 5. However, it’s not too late for Congress to act and extend the 0 supplemental. Economist, like Sheirholz, hope they do.“That extra 0 per week for people who are getting unemployment insurance is supporting spending of millions of people and that supports the broader economy,” said Sheirholz. “We estimate that if the 0 additional UI payment is allowed to expire this country will lose over 5 million jobs over the next year.” 1859

Medical offices around the country are opening back up for routine health checks and they're facing a huge problem; there's still a shortage of protective gear. Now, many are spending huge amounts of money restructuring the way they operate to keep themselves and their patients safe.On a window ledge at ENT and Allergy Associates in White Plains, New York, sits a number of brown paper bags. Inside, face masks labeled for each physician.“We have paper bags on our window sills with a bunch of masks. In there, we have 3-4-5 masks we’re rotating through. Those have to be kept covered to protect them from splatter or anything because once they get dirty, then they have to be thrown out,” Dr. Daniel Gold said. “We circulate gowns as well.”Gold is an E.N.T., which is the medical and surgical choice for anything having to do with the ears, nose or throat. It's a profession that is very much in your face, so protective gear is of utmost importance.“After wearing them for 5-10 minutes, you get short of breath and you’re like this is really hard,” he said.Doctors like Gold are having a hard time getting more gear. In fact, Dr. Gold often uses shields that are designed for sheet metal work because medical grade equipment is back ordered, or entirely unavailable. A surgical mask which once cost 30 or 40 cents now costs to .50.They've also found that knockoffs are being sold.“Not made of same material, not sealing against the face, and some had seam lines and then when you really looked, you’d realize there were holes through the seam lines that’s not blocking 95%,” Gold said. “You’re better wearing a t-shirt mask.”Dr. Gold is far from alone on this issue. It's a statewide and nationwide problem. Dr.Bonnie Litvack is the president of the Medical Society, State of New York.“That is an absolute mess because we can’t deliver the care if we don’t have the resources and the mask is ground zero for that,” Said Dr. Bonnie Livtack, the president of the Medical Society of the State of New York.When asked about whether they were able to negotiate for price on PPE, Litvack said, “With the various companies they either have it or they don’t, or you pay the prices or you don’t.”Dr. Litvack joined other state medical societies in the country by sending a letter to the Senate. They're asking the government to step in."We urge Congress to prioritize the production, distribution, and availability of PPE and testing, and accelerate efforts to conduct contact tracing,” the letter read. “All of these are essential to the safe reopening of medical practices and the economy and must be prioritized for all health care workers."They're also asking for financial help as their costs to operate, while seeing half the patient volume, are mounting.“These additional precautions and equipment is running us about per patient,” Dr. Gold said. “It’s about a million in extra overhead a month just in these extra masks, and gowns, and gloves and wipes. All these other things, which nobody could have thought to budget in because who would have thought we’d have to consider every patient highly infectious.”It's a new way of operating, as everyone is learning how to function in our new, post-pandemic world. 3229

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