Suicide killed more American troops last year than combat in Afghanistan, and that is likely to be the case again this year.
According to the Pentagon, there were at least 349 confirmed suicides in 2012, compared with 310 U.S. combat deaths in Afghanistan in the same period.
Historically, the suicide rate in the military has hovered around half the civilian rate. But in 2004, that changed: The rate doubled, and now it's on track to overtake the civilian rate.
Maj. Gen. Dana Pittard, the commanding officer at Fort Bliss until last month, spearheaded efforts to break the taboo on seeking help for mental issues. Pittard, shown here at Fort Bliss in 2012, also implemented mandatory interactive suicide prevention training.
The causes and remedies of the suicide epidemic are complicated, but one Army base in Texas has bucked the trend: At Fort Bliss, the suicide rate actually went down last year. In fact, it's declined consistently over the past three years: down to five suicides in 2012 from 12 in 2010.
"It was kind of a no-brainer," says Maj. Gen. Dana Pittard, who last month finished three years as the top commander at Fort Bliss. "Our focus was getting our soldiers to [get] help."
"In 10 years, only one case [of suicide at Fort Bliss] that we know of ... took place when a soldier was in treatment," says Pittard.
Pittard has battled to overcome the military's macho culture that considers reaching for help a sign of weakness. He mandated that all troops arriving at Fort Bliss take a two-day suicide awareness and prevention course that was different from the training used by the rest of the Army.
The program, which uses a more interactive approach, including role-playing, stresses action and intervention by peers to help troubled soldiers. But asking if someone feels suicidal is just the first step.
"That is the hard part. Ask the questions," says Storey Smith, a social worker, who teaches suicide prevention at Fort Bliss.
"But then the next thing that happens is if the answer is, 'Yes,' what do I do?" she says. "Equally important, if the answer is 'No,' is he really OK?"
