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Over the first 155 days of 2012, the Department of Defense lost 154 service members to suicide. The Air Force, like the rest of the DoD, is working to reduce the incidence of suicide attempts through the Resiliency Element, the outreach wing of mental health services.

"We're all about making sure we're being good Wingmen, taking care of each other, recognizing the signs and symptoms of a potential suicide attempt, and identifying resources for difficult times," said Cmdr. Janet Cochran, Resiliency Element Leader at the 779th Medical Group.

Part of that outreach takes part on Wingman days and Standdowns. The message, Cochran said, is, "There are services available, not only through us. You don't have to see us. Just see someone."

That can include a call to a crisis hotline or the Emergent Care Center, or to the clinic during regular duty hours. Many individuals struggling with depression or suicidal thoughts turn to Military One Source, or avoid interaction with military-affiliated counselors by opting to see a health care provider outside the fence line.

"There is a large TRICARE service network in the area," Cochran said, but people are free to discuss their concerns with any health care provider, no matter what their specialty. "There is no 'wrong door.' We'll do whatever you need to help you, before you go where you need to go."

Mental health professionals are now embedded in the primary care clinics of the 779th Medical Group, as part of the new Behavioral Health Optimization Program. B-HOP allows patients to get the care they need without being seen at the mental health clinic or having a mental health record opened on them.

Generally, they can keep a lot of their patients in house, but they can refer to us as needed," Cochran said.

No matter where you go for health care, there are formal survey tools that can help identify the risk factors and protective factors in an individual's life. Traditionally, just being an active duty service member has counted as one of those protective factors, although that has become less true over the past five to 10 years, Cochran said.

"We're still not able to get a good handle on why that is," Cochran said, "But the protective factors that allow people to deploy are the same protective factors that make people less likely to attempt suicide. Deployment is not strongly correlated with attempted or completed suicide."

Part of Cochran's role as Resiliency Element Leader is to track and report suicide statistics from Joint Base Andrews to the Community Action Information Board and the Integrated Delivery Services. On JBA as in the rest of society, suicide attempts are most common among men ages 20-24, and men who attempt suicide are more likely than women to complete it, mainly because men tend to have more ready access to lethal means. Most months, there is at least one suicide attempt on JBA.

"One attempt is one too many. There was none in August. We need to make that the norm," Cochran said.

No matter what programs might be available on the installation or throughout the DoD, the real assistance has to come from somewhere a lot closer to the heart. Friends, fellow Airmen, family members and supervisors are often ideally placed to help an individual struggling with thoughts of suicide. People who see each other often and are involved in each other's lives can be the first to know when someone needs help. The Resiliency Element encourages everyone to be an ACE Wingman--Ask, Care, and Escort.

"So many people skirt around the issue because they're uncomfortable. Ask the question directly. 'Are you thinking of hurting yourself? Are you thinking about killing yourself?' It doesn't put the idea in their head. They'll say yes or no, and it's a question that lets people know you're there and caring about them," Cochran said. "Sometimes, people are not aware of how they're presenting. It can make people think, 'Maybe I do need help,' even if suicide is not their intent."

Warning signs can include dramatic mood changes, social withdrawal, worrying, anxious behavior, thinking and talking about suicide, increases in substance abuse, a lost sense of purpose, helplessness and hopelessness.

"Know your people. If he has a girlfriend, and he stops talking about her, ask. 'Are you still seeing her?' Breakups can bring people emotionally down, and if nobody's aware they can't help you through those difficult times. Especially for young Airmen, it's good to have someone who can assure them that every day it gets easier, and friends and family are there to help you, hopefully," Cochran said.

The transient nature of the military can leave people without a strong network of nearby loved ones.

"Your best friend can PCS next week. Who steps in to fill that void?" asked Cochran. "As the DoD, we try to support the individual, but in a region as large as the National Capital Region, after work we don't necessarily see each other as we do at small bases and overseas locations."

Chaplains are often the first line of defense against suicide. People who aren't comfortable talking with a medical professional or a crisis hotline staffer can be more willing to share their pain with a chaplain.

"Sometimes, people contact us directly because of their own suicidal thoughts, or a Wingman or a supervisor will take them to the chaplain," said Chaplain Lt. Col. Lisa Tice. "People are more willing to talk to a chaplain, even people without a religious affiliation, because of our total confidentiality. We won't talk to anyone else."

Tice said that the Air Force is "getting over the stigma" of suicide, which helps individuals get the help they need.

As chaplains, "We listen. We talk to them about what's going on, why they're feeling what they feel, what life means to them in religious terms. We assess, and we refer. Sometimes, we bridge the gap with Mental Health. If they look like an imminent danger to themselves, we will go with them to the emergency room," Tice said.

Chaplains provide short-term counseling and other continuing care.

For more information on local suicide prevention programs and a list of suicide crisis hotlines, visit afdw.af.mil/library/resiliency/index.asp.

To learn about the Behavioral Health Optimization Program, contact Lt. Cmdr.. Heidi Daniels at 240-857-5075.