Suicide in the UK armed forces: Prediction is difficult, prevention is complex, a strategy and plan now bring critical coherence

Abstract: Every death by suicide is a tragedy, with a devastating effect on friends and family. Within the Armed Forces, this impact also extends across the unit and wider serving community. In total, 287 regular UK service personnel have died by suicide in the last 20 years, between 2003 and 2022, with a further 29 deaths awaiting an inquest. With a historically lower risk for UK personnel, there may be protective factors inherent in service life. Pre-entry and in-service fitness standards generate a selected population where healthy worker and healthy warrior effects apply. Those with serious ill health are excluded and levels of fitness are higher, introducing a ‘survivor’ bias. Service life also reflects personnel being in work, receiving a regular salary, with provision for single accommodation or family housing. The USA established the Suicide Prevention and Response Independent Review Committee, completing a comprehensive evaluation in 2022 for the US military population. Suicide is highlighted as a wicked problem, with complex interdependencies, calling for a shift in solution-focused to process-orientated thinking. This review generated over 100 recommendations, within four distinct pillars: healthy individuals, families and communities; community prevention services; support and treatment; research and surveillance. The context and thematic areas for intervention are thus increasingly clear, and to make real impact in the UK, a collaborative approach has been necessary. In 2023, the Armed Forces Suicide Prevention Strategy and Action Plan was published, to meet the health outcome ‘reduced incidence and impact of suicide’. The Defence Medical Services will necessarily focus on several strategic areas; to enhance organisational management for individuals at risk of suicide and to enable access to appropriate interventions. Although suicide remains a rare event in the UK Armed Forces, and the overall risk is lower than the general population, there is no complacency. The recent strategic objectives and action themes, which are wide ranging and engage all areas of the organisation, demonstrate a commitment and present an opportunity to prevent the tragedy of future deaths by suicide.