CONWAY, Ark. - The death of Army Spc. Josh Farmer intensified the state of Arkansas' focus on helping troubled Soldiers and Airmen.
Farmer died by suicide Sept. 20, 2009. Among initiatives prompted in part by his death: A unique memorandum of understanding between the Arkansas National Guard and the Department of Veterans Affairs that greatly increased the Guard's ability to intervene before it is too late.
"Sometimes Josh said he needed help; sometimes he did not think he needed help," said Stephanie Farmer, Josh's widow, who visits her husband's grave here about once a week because it is where she feels closest to him.
"Josh was a good talker. He could make you think he was OK. He could hide his feelings very well," she said.
Farmer's gift for talking enabled him to persuade doctors he should be released whenever he had second thoughts about treatment.
At the time, Arkansas Guard officials could get little information about patients. They were not notified when troubled servicemembers left treatment. They were powerless to force hospital stays.
No more.
Among initiatives in the MOU signed three months and one day after Farmer's death:
- Information provided by the National Guard can be used to support involuntary hospitalization.
- Guard officials can testify in court if necessary to support hospitalization.
- The National Guard is notified about pending discharges and planned follow-up care.
- The Guard is told if a patient walks away from treatment.
- If another Arkansas hospital turns the patient away, the Guard can obtain help from the VA.
"We are able to make a difference now," said Army Capt. Tanya Phillips, state suicide prevention program manager. "That doesn't bring Josh back, but because of him … something positive may have occurred."
The MOU effectively makes Arkansas Guard officials part of a Soldier or Airman's treatment team. Guard leaders meet with psychiatrists, social workers and the patient. And the Guard is better able to involve family members and representatives from the servicemember's chain of command.
When he was healthy, Josh Farmer left an impression on people that translated into a standing-room-only funeral attended by hundreds.
"Josh was the type of person that you would want to go out of your way for," Stephanie Farmer said. "Smart. Caring. The best dad in the world. He was just the nicest person. Never fought with anybody - even with me. I got everything I wanted. He would do anything for you."
When healthy, Farmer was proud of being a Citizen-Soldier.
"It made him feel like he was somebody," said Stephanie Farmer, who, along with her mother, Norma Gail Gunter, recalled how the family went to South Carolina to see Farmer graduate Basic Combat Training and how he returned home talking loud like a drill sergeant and liberally peppering conversation with a strong "Hooah!"
"He was so proud to be a Soldier," Gunter said. "He really was."
When healthy, Farmer would go back into a store to pay more money because he had accidentally been undercharged for gas. He took college classes. He worked full-time for an office supply business.
A musician who played multiple instruments, he could hear a song one time on the radio and be playing it 30 minutes later. He was active in a church youth group and played in praise bands at two different churches.
But Farmer wasn't always healthy. He was treated for anxiety. He sought treatment for alcoholism. He used medications that had not been prescribed to him.
Medical issues threatened to derail deployment to Iraq. Farmer was sent back from mobilization training at Camp Shelby for a back issue to be addressed and to be taken off an anti-anxiety medication.
When he saw local news reports about his unit, he was distraught, saying he was a failure. "I'm supposed to be with them," he told Gunter.
A fire started by an electrical fault gutted the 90-year-old home Josh and Stephanie had shared. Josh got an intoxicated driving charge. He made a couple of suicide attempts. He stole and crashed a pickup truck.
After a stint in rehab, he successfully lobbied to go to Iraq, joining his unit five months late as a supply clerk and returning home with them in time for Christmas 2009.
"It was a hard time for families to get reunited," Phillips said. "It's a very stressful time of year, and we started seeing problems immediately from the return - psychiatric problems, reunification problems, just integration problems, Soldiers not having jobs to come home to because the economy had bombed while they were in Iraq."
Farmer and his wife separated, in part because Stephanie said she was concerned about the safety of their young son after Josh drank before the boy's birthday party. They still talked daily, and they were working on their marriage, but they lived apart.
He started keeping secrets. "He got to hiding it, like he knew he was doing wrong," Gunter said. "Something wasn't right. It scared him."
Gunter, a registered nurse, was alert to the warning signs. Sometimes her son-in-law slept all day. Sometimes he didn't sleep at all and woke her for long late-night conversations about his problems. His drinking and pill use accelerated. He talked about being better off dead.
"He was crying out for help," Gunter said. "I'm an RN, and I have seen a lot of things, and I have never seen a person with that blank, dead stare."
Gunter still has the inch-thick manila folder in which she filed every paper related to her son-in-law's multiple attempts at treatment.
He would get treatment, mostly through the VA, but then he would decide he did not need it anymore.
"He needed to be committed," Stephanie Farmer said. "He needed to be kept for at least a while. He needed [time] to process."
Josh's family feels that treatment providers - hearing the persuasive part of him that said he was OK - turned him away too easily.
"I took him to the VA I don't know how many times, and they kept saying he didn't need help," Gunter said. "He fell through the cracks. The medical part should have included the family more, because the family knows how they are. A crazy person's not going to say they're crazy. They're going to say anything but that."
Doctors were hamstrung because, before the MOU, they had to hear from the patient, it was not enough to have the word of family or unit members.
The MOU has made it easier for doctors to draw on information from a troubled Soldier or Airman's Guard colleagues.
"One of the things that we found in Central Arkansas was the National Guard oftentimes would be the first point of contact for a servicemember who might be suicidal," said Dr. Tina McClain, associate chief of staff for mental health for the Central Arkansas Veterans Healthcare System. "They would maybe bring the servicemember up to the VA, and then the VA doctor maybe wouldn't see with their own eyes. The servicemember might deny at that point that they were suicidal.
"Arkansas state statute says in order to put someone on an involuntary hold for commitment, you have to be an eyewitness to an at-risk behavior or have firsthand knowledge, … So we would then say, 'We can't admit this person, because we don't see what you guys are seeing.'
"That led to a lot of frustration from our clinicians as well as on the part of the Guard. Our clinicians were saying, 'We believe the people from the Guard, but we can't do anything about it, because we didn't hear it ourselves or we didn't see it ourselves. So the clinicians were frustrated. There had to be something more we could do.
"At the same time, the Guard was frustrated, because, 'We brought him up there, and you guys didn't do anything.' "
Josh Farmer's death was the last straw.
He spent the last day of his life with his 3-year-old son, who could not choose between a Batman or Spiderman costume for Halloween, so his father texted Stephanie that they should pick the outfit together the following weekend.
He saw his mother-in-law, making the eye contact he would not make when he was drinking or using.
He put on his pajamas to go to bed - and sometime later that night he killed himself. It was Stephanie's birthday, and the two had planned to spend it together.
No one but Josh will ever know, but his family feels it was an unpremeditated, spur of the moment suicide made easy because a weapon was at hand - the kind doctors say is hardest to prevent.
"It blew me away," Gunter said. "What did I miss? What signal did I not pick up on? I played it through my mind and still play it through my mind. There was nothing there to get."
Said Stephanie, "You wonder why you couldn't fix it. In my case, why me and my son weren't enough. You get mad, and then you get sad. I relive what he must have been going through. That's the hard part, is to imagine that point, because you would have to feel so alone. None of it makes sense, and it won't. … It's just the acceptance, knowing he was sick and that nobody could help. I don't think that they think about the people that are left behind, but in that state of mind … I don't know that they're capable of thinking about that. He didn't know how much it was going to hurt everybody."
Gunter said it's crucial to persist until you find help for someone encountering a mental health crisis.
"Don't give up," she said. "Keep going back to the doctors. Make them listen to you more. Don't just leave it. Keep pursuing it until he gets the help."
Stephanie Farmer said the responsibility at least partly lies with the person who needs help.
"It all depends on the person, if they want the help," she said. "Regardless of whether you have 500 people sitting here waiting, asking, 'What do you need me to do?' The person has to be ready. Josh was ready. If he could've gotten the help, he could've gotten better."
After Josh died, the VA assembled a team, including the Arkansas Guard, to create the MOU within existing state statutes, verifying with the circuit court that nothing about it violated due process.
"We've had some very successful interventions because of the new memo," Phillips said. "It's something positive that came from something negative."