At Fort Meade, where the suicide rate among service members is six times higher than that of the entire state, a crowd of 75 soldiers offered mostly silence when Mark Fisher asked them to list potential warning signs that a colleague is about to take his or her own life.
"The only way we're going to attack suicides is to talk about it," Fisher urged them. "We have to get it. And this is the only way."
Fort Meade's mandatory suicide prevention training Wednesday was part of an Army-wide initiative undertaken as the military branch is on pace to reach its highest-ever suicide rate. The number of suicides each year has nearly doubled since 2005, from 87 to 165 last year. And the number of monthly suicides doubled from June to July — when suicides outpaced combat deaths of active-duty soldiers.
Aberdeen Proving Ground will hold its "stand down" training Thursday as military installations around the globe temporarily halt operations to focus on suicide prevention.
"Out of 365 days of the year, we're taking a day that was otherwise devoted to something else and saying: That's not as important as this," Sgt. Maj. of the Army Raymond F. Chandler III said in a conference call.
"The nation has asked our soldiers to carry a heavy load over the past 11 years, and they have not let us down. But suicide is an enemy we have yet to beat."
At the current pace, the Army's suicide rate would be its highest yet at 29 deaths per 100,000 people this year. Fort Meade saw six suicides within the past 12 months among its military population of 11,600 people, base spokeswoman Mary Doyle said. Based on those numbers, the rate for Fort Meade would be more than 50 per 100,000 people.
Maryland's suicide rate in 2010, the most recent year for which data is available, was 8.4 deaths per 100,000 people.
Army officials and psychiatrists hesitate to name a single cause for the rise in suicides. "It'd be almost impossible to put one reason to the spike," said Troy A. Rolan Sr., an Army spokesman at the Pentagon.
Dr. Adam Kaplin at the Johns Hopkins School of Medicine, who last year sat in on monthly review of suicide cases at the Pentagon, said the reasons for the rise are complex and numerous. "The fact that we've been at war for more than a decade is playing a role, the fact that the economy is bad is playing a role."
Fisher, who ran Fort Meade's suicide prevention training, offered many reasons — the extra strain the military puts on relationships, financial woes, drug and alcohol use, and injuries.
"We've broken a lot of soldiers and sailors and Marines," Fisher said. "A lot of times, people kill themselves just to get away from the pain."
Cmdr. Marivic Fields, who is in charge of health promotion on Fort Meade, said five of the six suicides at the base happened within the past nine months. Several people who committed suicide had been facing disciplinary problems, Fields said, exacerbating what researchers say are two main reasons for suicide: feeling like a burden and the loss of connectedness.
"It's still that sense of shame that 'I'm not worth anything,'" Fields said.
The Army hopes to confront a culture in which mental illness can have a stigma and where, at least in the past, mental health care could have limited access to someone with a security clearance.
"What things do we need to change inside of the institution to create this culture where it is a position of strength to ask for help?" asked Chandler, the highest-ranking enlisted person in the Army.
Scott J. Salvatore, a psychologist and a commander with the U.S. Public Health Service at Fort Meade, said that in 2008, the military stopped asking about mental health care related to combat, grief or marital problems when screening soldiers for security clearances. Yet, he said, the myth remains that seeing a psychiatrist would jeopardize security clearances, and thereby jeopardize careers.
"It is a big stigma, and a barrier to those seeking care," Salvatore said.
The Army regularly has "stand-down" days to focus training on specific subjects, most recently on drunken driving and information technology, said Rolan, the Army spokesman at the Pentagon. The last Army-wide "stand-down" training for suicide prevention was in 2009.
Fort Meade soldiers, along with civilians and leaders, were taught to detect suicide warning signs, then instructed to ask people whether they needed help, to listen and escort them to aid when necessary.
"Don't leave them," Fisher said. "I don't care if you've got to smoke, if you've got to pee. You don't leave."
Kaplin, of Johns Hopkins, said the Air Force turned around a high suicide rate in the 1990s, but he questions whether the Army's campaign will do enough. Successful programs, he said, go beyond delivering help to those who need it and include a sense of accountability from everyone.
Col. John B. Wells, commander of the U.S. Army Claims Service at Fort Meade, said the Army's culture runs counter to some of the training given Wednesday.
"You teach people to be strong and, in the face of adversity, to not show emotion," Wells said. "Your duty as a soldier is to obey and not talk back, to take orders. There's little room for you to say that you need help."
Part of the training addressed that. It focused on resilience, teaching soldiers to be able to bounce back from stress and control their reactions.
Learning the warning signs of suicide, Wells said, was a lesson learned too late.
Wells' friend in the Judge Advocate General's Corps took his own life with a service revolver. Another friend killed himself in law school. And not that long ago, just before school started, a 15-year-old neighborhood boy hanged himself at the playground. Just days earlier, Wells said, he'd wondered if there was something wrong.
"I think there were probably signs or signals — something — that I should've noticed," Wells said of each death. "But I didn't think it was my business. That's kind of weighed on me, in reflection. Should I have been there? Could I have done anything?"
The Army's training, Wells said, made clear that he should have done something.
"I probably should have reacted," Wells said. "You have a responsibility to the soldier to the left and right of you."
Recent annual suicide rates per 100,000
Fort Meade: 50
Sources: Department of Mental Health and Hygiene, U.S. Army statistics, Fort Meade officials