Seven years after the rate of suicides by soldiers more than doubled, the Army has failed to reduce the tragic pace of self-destruction, and experts worry the problem is a "new normal."
"It's very clear that nothing that the Army has done has resulted in the suicide rates coming down," said Carl Castro, a psychologist who retired from the Army in 2013, when he was a colonel overseeing behavioral health research programs.
The sharp rise in the Army's suicide rate from 2004 through 2009 coincided with unusually heavy demands on the nation's all-volunteer military, as hundreds of thousands of troops, most of them in the Army, deployed to Iraq and Afghanistan. The vast majority have since come home, but suicide rates remain stubbornly high.
The Army's suicide rate for active-duty soldiers averaged nearly 11-per-100-000 from Sept. 11, 2001, until shortly after the Iraq invasion in 2004. It more than doubled over the next five years, and, with the exception of a spike in 2012, has remained largely constant at 24-to-25-per-100,000, roughly 20% to 25% higher than a civilian population of the same age and gender makeup as the military.
Since the Army is the largest service branch in the military, the Pentagon suicide statistics reflected a similar increase.
"Seven years of relative stability at these profoundly higher rates may well be the new normal," said David Rudd, president of the University of Memphis, who served on a panel of scientists that reviewed military mental health programs and issued a critical report in 2014.
Rudd worries that a sense of heightened concern that gripped Congress and the Army when military suicides spiked has dissipated. "You don't see any significant outrage about it now," he said.
The Army used to post suicide statistics promptly each month, but data is now published by the Pentagon each quarter and often is delayed for months.
"I do think there is a sort of creeping mind-set of, 'Well, this is just how it is now,' " said Craig Bryan, executive director of the National Center for Veterans Studies at the University of Utah. "The sense of urgency about this problem has started to fade away."
Deaths, however, persist at only too regular intervals.
In late January, Army Maj. Troy Donn Wayman, 44, shot himself to death in his home near Fort Hood, Texas, according to Army Times. Wayman had deployed five times in his career, including twice to Iraq. Fort Hood, one of the Army's largest bases, still suffers more than one suicide per month on average, a level unabated for several years.
Scientists still don't know exactly why suicides increased so dramatically in the military. Major studies have shown no direct link between the deaths and being deployed overseas, and suicide increased even among soldiers who did not deploy.
Many experts remain certain that combat is a crucial factor of suicide, and that after 9/11, the Army came under enormous pressure. Scientists argue that deployment does not always equate to combat. Many troops are sent to non-combat zones or serve on large bases with little exposure to violence.
Lt. Col. Chris Ivany, Army director of behavioral health care, said mental illness is linked to suicide and noted that the illness rates have also risen. Combat experiences are known to cause behavioral health problems such as post-traumatic stress disorder or depression.
"(Suicide) rose during a period of war, and it's just implausible to me to discount the role that being at war might play on the changing environment of Army service," said Michael Schoenbaum, a scientist with the National Institute of Mental Health who is involved with a $97 million ongoing study into suicide in the Army.
Schoenbaum and others say lower suicide rates in the military before wars in Iraq and Afghanistan made sense. Soldiers, in a period of peace, have advantages that should make them less susceptible to self-destructive urges. Unlike many civilian peers, soldiers have jobs, health insurance, stability, a sense of purpose and are screened for mental and physical issues before entering the military.
"You would expect a particular version of the healthy worker effect," Schoenbaum said. Fifteen years of sustained conflict may have altered that effect, he said.
"When you look at the duration of these elevated (suicide) rates," Rudd said, "you have to conclude that military culture has changed and that this is, in fact, the new reality."
Castro, the former military behavioral health research chief, said the Army never has conducted the kind of peer-reviewed studies necessary to see if its suicide prevention programs actually work.
"They would roll out new programs that would use new technology. But never did they assess whether or not it was improving knowledge, improving awareness, deterring people from thinking about suicide," said Castro, an assistant professor at UCLA. "Nobody in the field wanted to wait for evidence-based prevention efforts. They just wanted to do something."
Pentagon officials say that is changing. Adam Walsh, director of research and program evaluation for the Defense Suicide Prevention Office, said a series of new programs enhancing peer support, suicide prevention training and interventions are being evaluated.
Ivany said the Army has had success in reducing hospitalization rates for mental illness.
"We know care is being delivered on the outpatient side. We think it's higher quality," Ivany said. "I absolutely hope that the rate will come down and we will work to do everything we can to make that happen. Whether or not it will come down is a separate question that I just don't think anyone is in a position to answer."