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The Power of Social Norms in Reducing Veteran Suicides – Part I

The issue of veteran suicides is a critical concern that requires urgent attention. The Department of Veterans Affairs has been implementing various programs and marketing campaigns to prevent suicide among veterans. However, despite these efforts, the number of veteran suicides has been on the rise. In this two-part article series, we will explore the potential of social norms messaging as an alternative approach to reducing veteran suicides.

Understanding Veteran Suicides: Contributing Factors, VA Efforts, and the Pandemic's Toll

The rates of veteran suicides in the U.S. are alarmingly high and have been for several years. According to the VA’s recent statistics, an average of 17 veterans die by suicide every day, which translates to roughly one suicide every 84 minutes, and it is more than twice the rate of suicides among the general population. Furthermore, the suicide rate among female veterans has increased by over 85% between 2001 and 2018, and the suicide rate among veterans aged 18 to 34 has increased by nearly 76% between 2005 and 2018. 

There are many factors that contribute to the increased rates of veteran suicides, including the experience of trauma during military service, difficulty transitioning back to civilian life, access to firearms, substance abuse, and the stigma surrounding mental health and seeking help. Although the VA has implemented various programs and initiatives aimed at reducing veteran suicides, the continued high rates suggest that these efforts may not be enough.

The VA’s initiatives to address the issue of veteran suicides include the Veterans Crisis Line, which is a free, confidential resource that connects veterans and their families with trained responders who can provide crisis counseling and support 24 hours a day, 7 days a week. The VA has also established suicide prevention coordinators at each of its medical centers to identify at-risk veterans and connect them with appropriate resources. Additionally, the VA has partnered with other organizations to share information and resources to address veteran suicide and has launched several public awareness and prevention campaigns, including the “Be There” campaign and the “REACH VET” initiative.

The COVID-19 pandemic has also exacerbated the problem of veteran suicides by creating new challenges for mental health care providers and may exacerbate existing mental health conditions among veterans. Research has shown that individuals who experienced financial insecurity, social isolation, and a lack of access to healthcare were at a particularly high risk of experiencing mental health challenges during the pandemic.

Overall, the VA continues to face challenges in reaching veterans who may be at risk for suicide, particularly those who may be reluctant to seek help or who are not connected to VA services. This article will explore new approaches and interventions to address the issue of veteran suicides and improve access to mental health care for veterans.

Rethinking Veteran Suicide Prevention Strategies

Despite the various resources and prevention campaigns implemented by the VA, the rates of veteran suicide have continued to rise. One major issue with the current approach is that it relies heavily on individual-level interventions, such as counseling or medication. While these interventions can be effective, they often do not address the underlying social and structural factors that contribute to veteran suicides, such as social isolation, economic insecurity, and lack of access to healthcare.

In addition, traditional prevention campaigns often focus on increasing awareness of mental health issues and encouraging help-seeking behaviors. However, research has shown that these campaigns may not be effective in changing behavior, especially among populations that are already reluctant to seek help.

This is where alternative approaches, such as social norms messaging, may be more effective. Social norms messaging is a communication strategy that aims to change people’s perceptions of what is normative and acceptable behavior by highlighting the actual behaviors of their peers.

For example, if veterans believe that seeking help for mental health issues is stigmatized or shows weakness, social norms messaging can counteract this by highlighting the fact that many of their peers are seeking help and that this behavior is actually normative and acceptable.

Social norms messaging can also be used to target specific populations or subgroups of veterans, such as those who are at higher risk for suicide due to their age, gender, or military experiences.

Understanding Social Norms and Behavior

Social norms are the unwritten rules that dictate behavior within a society or group. They are a shared set of beliefs, values, and expectations that determine how people should act, what is considered acceptable or unacceptable behavior, and the consequences of certain actions within a particular social context.

Social norms play a critical role in shaping human behavior as individuals tend to conform to socially acceptable behaviors and attitudes within their communities. This conformity arises from the social pressure to fit in and be accepted by others. Individuals may fear rejection, criticism, or social exclusion if they deviate from these norms.

For example, in some cultures, talking with one’s mouth full during a meal may be considered impolite, and violating this norm may lead to social disapproval or embarrassment. Similarly, norms around drinking, drug use, or suicide can influence whether individuals engage in these behaviors and shape perceptions of these behaviors as acceptable or unacceptable.

The influence of social norms extends to how individuals perceive and respond to suicidal ideation and help-seeking behaviors. Some cultures and communities attach a social stigma to discussing mental health issues, including suicidal ideation, leading individuals to conceal their struggles and make it difficult for them to seek help. Conversely, in other cultures or communities, discussing mental health issues is more acceptable and can result in better outcomes and earlier interventions.

In military and veteran communities, several prevalent social norms related to suicide and help-seeking can contribute to a reluctance to seek help for mental health issues and suicidal thoughts. One such norm is the belief that seeking help for mental health issues is a sign of weakness, making it challenging for service members and veterans to seek help, fearing stigmatization or judgment from their peers. Additionally, there may be a perception that discussing suicidal thoughts or behaviors is taboo or inappropriate, leading to shame or embarrassment for those experiencing suicidal ideation, preventing them from seeking help. Finally, there may be a perception that seeking help for mental health issues or suicidal thoughts may negatively impact one’s career or military service.

To reduce the stigma associated with mental health issues and encourage help-seeking behaviors among veterans, it is essential to address these social norms. Creating a culture that values mental health and supports help-seeking is vital. By doing so, veterans can feel more comfortable seeking the assistance they need without fear of judgment or stigma.

Social norms significantly shape help-seeking behaviors among veterans, affecting their perception of what is normative and acceptable behavior. If veterans perceive that help-seeking is weak or unacceptable, they may be less likely to seek help, even if experiencing significant distress. Addressing these social norms is necessary to encourage help-seeking behaviors among veterans. Reducing the stigma associated with mental health issues and promoting help-seeking through social norms interventions is critical. Creating a culture that values mental health and supports help-seeking can be achieved through these measures.

What the Research Says

Research on social norms and suicide prevention has shown promising results in recent years. One study published in the Journal of Consulting and Clinical Psychology found that a social norms intervention can reduce suicide ideation and attempts among college students (Huh et al., 2015). The study involved a randomized control trial in which students were given either a brochure on mental health and suicide prevention or a brochure that included information about the actual prevalence of suicide among college students, which was lower than what students believed. The latter group had a significant reduction in suicide ideation and attempts compared to the control group.

Another study published in the Journal of Health Communication found that social norms messaging was more effective than traditional anti-stigma messages in promoting help-seeking behavior among military personnel (Bray et al., 2016). The study involved a randomized control trial in which military personnel were exposed to either a social norms message or an anti-stigma message. The social norms message focused on the fact that seeking help for mental health issues was a normative behavior among military personnel, while the anti-stigma message focused on reducing stigma associated with seeking help. The social norms message was found to be more effective in promoting help-seeking behavior than the anti-stigma message.

A review of the literature on social norms and health behavior also found that social norms interventions can be effective in promoting behavior change (Berkowitz, 2004). The review found that social norms interventions were particularly effective when they corrected misperceptions about normative behavior and when they were delivered by credible messengers.

From Social Norms to New Habits: Understanding the Link ​

People are strongly influenced by what they perceive as the normative or typical behavior of others around them. Therefore, social norms can play a significant role in shaping attitudes, beliefs, and behaviors.

Research has shown that social norms can be used to promote behavior change in a positive way. This is because people are more likely to adopt behaviors that they perceive as normative or typical within their social group. For instance, when people perceive that their peers are engaging in a particular behavior, they are more likely to adopt that behavior themselves.

Social norms can also be used to change negative or harmful behaviors. For instance, in the context of reducing veteran suicides, social norms can be used to change perceptions of what is normative and acceptable behavior around suicidal ideation and help-seeking. By promoting positive social norms around seeking help, it is possible to encourage more veterans to seek support for their mental health concerns.

One of the key advantages of social norms messaging is that it can be more effective than traditional awareness or prevention campaigns. This is because social norms messaging focuses on promoting positive behavior rather than highlighting negative or harmful behaviors. It also draws on the power of social influence, which can be more compelling than other forms of persuasion.

Research has also shown that social norms messaging is most effective when it is tailored to the specific group or population being targeted. This means that messages should be designed to appeal to the norms and values of the particular social group in question. For instance, social norms messaging aimed at reducing veteran suicides should be tailored to the unique experiences and challenges faced by veterans.

In part 2 of this series, we discuss the social norms marketing framework and practical implementation of shifting negative behaviors. 

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