Veteran Suicide - A Very Real and Serious Issue

For nearly a decade, the veteran community has called for action by our nation’s leaders to respond to the 20 veterans a day suicidal rate. The issue of veteran suicide is now a major conversation in media coverage, national conversation, and demanded a surge in government support.


Yet, the problem of suicide continues. According to recent VA data, post-9/11 veterans between ages 18 to 34 have the highest rate of suicide. Though not always an indicator of suicide, mental health injuries continue to impact the post-9/11 generation. Surprisingly, 65% reported PTSD, and 58% anxiety, and 56% depression. The nation and VA continue struggling with mental health care and providers’ demands, two of the top VA staffing shortages.


There has been some progress. In mental health injuries, 3 in 4 are seeking care for their injury. Over the past few years, increased progress has been made in the realm of suicide prevention and mental health. The VA’s plan for transitioning veterans’ targets those in the post-9/11 population as an increased risk of suicide and engage them before the moment of crisis. The VA has leveraged telemental health care to expand its reach and predictive analytics to target the top 0.1% of veterans at risk for suicide.


According to a recently released report by the Department of Veterans Affairs veterans’ suicide rate ticked upwards recently despite increased public attention and funding on this problem.


However, the latest data still does not represent the present conditions. According to mental health experts, this ongoing coronavirus pandemic may cause larger increases in the rates of mental distress and self-harm among veterans.


Approximately from 2005 to 2018, the overall suicide rate has remained mostly unchanged, between 17 and 18 veterans a day. This rate is about 1.5 times that of the civilian population, according to the Department of Veterans Affairs (VA). Among veterans, suicide rates remain about the same as the civilian U.S. population, but both are rising. Recent studies have announced that 325 active-duty members died by suicide in 2018, 40 more than in 2017, which has been the highest number since data started to be collected in 2001. Nobody knows why suicide rates continue to climb. Numerous public figures and awareness campaigns in recent years have quoted the figure of “20 or 22 a day” in reference to veterans’ suicide, but VA officials clarified that this estimate includes active-duty troops, guardsmen, and reservists.


Many fault demographics—85 percent of the veterans are male, and men die by suicide more often than women. But we also know that even female veterans die by suicide at a higher rate than civilians. In the 2019 VA suicide prevention annual report, women veterans’ suicide rate was 2.2 times greater than that of civilian women.


In addition to the demographics, factors of insomnia, depression, anxiety, sexual victimization, gun ownership, and substance use disorders also appear to contribute to suicidal risk. Older veterans also cope with aging, stress, or lingering effects of their military service that has never been addressed from the past, while many recently discharged veterans seem to have trouble with their relationships or transitioning challenges back to civilian life.


Now, psychologists within and outside the VA are leading efforts to improve suicide risk assessment and research to better understand and prevent veteran suicide. They are also developing and piloting interventions at both individual and community levels to respond to this deadly issue.


The recently released figures show that veterans who have died by suicide in 2018 were 6,435, up less than half a percent over the total veterans’ population. By comparison, there have been 7,032 troop deaths in conflict zones since 9/11, according to Defense Department statistics.


Veterans suicides made up approximately 14 percent of the total suicides in America in 2018. In recent years, VA officials have emphasized that mental health challenges and suicidal thoughts are not specific to the veterans’ community.


Findings highlighted the increasing problem of suicide among U.S. civilian adults and veterans and the need for suicide risk mitigation efforts.


Despite the lack of general progress in suicide prevention among veterans, some improvements have been occurring. Data shows that the rate of suicide among veterans who have used VA health services has decreased, and it is an encouraging sign that the department continues to learn as its works and cares for veterans.

The suicide rate among veterans who receive VA care has decreased by about 2.4 percent from 2017 to 2018.


Data has shown that suicide is indeed preventable through clinical and community-based prevention interventions, along with research and surveillance within the VA.

Although this report explains that suicide is preventable, suicide prevention is exceptionally complex.


Recently, Senate lawmakers passed a package of nine VA-themed bills to improve the department’s suicide prevention efforts. However, new incentives for the safe storage of firearms among veterans were proposed. A VA suicide report shows that firearms were involved in more than 68 percent of veterans suicides in 2018 compared to 48 percent of the rest of the American population.


A recent statistic has been widely quoted in the veteran community that highlights “22 veterans a day” committing suicide. It is a profoundly troubling statistic and has galvanized the veteran movement, both from inside the veteran communities and outside, to bring about a wide range of programming nationwide. The statistic, however, is widely misrepresented and misunderstood.


This statement — 22 veterans a day commit suicide — while widely advertised by politicians, media outlets, veterans service organizations comes from the VA’s 2012 Suicide Data Report, which examined the deaths of 21 states from 1999 to 2011. The report found that the estimated number of veterans was compared from a sample number of states, and evidence was uncertain in veteran identifiers on U.S. death certificates. An example shows that veteran suicides’ average age was nearly 60 years old, not representative of the Iraq and Afghanistan veterans’ generation.


A more current study surveyed 1.3 million veterans discharged between 2001 and 2009, discovering 1650 deployed veterans and 7703 non-deployed veteran deaths. Three hundred fifty-one of those were suicides among deployed veterans, and 1517 were suicides among non-deployed veterans. So, over nine years, there was one veteran suicide a day.

Although veterans have a suicide rate 50 percent higher than those who have never served, the rate of suicide was slightly higher among veterans who never deployed, which suggests that these causes extend beyond the trauma of war.


Coming home from war or merely transitioning from the military can be difficult. Various state and federal systems are set up to deal with this transition, how, ever cannot meet the need. Many people think that Veterans Affairs benefits programs like medical care, the G.I. Bill, the VA Home Loan, etc. are not helpful; however, they are. But, for the current generation of veterans from Operation Iraqi Freedom and Operation Enduring Freedom, the suicide rate is closer to probably one a day and most likely occurs within the first three years of return. While this is still very troubling, it definitely is not 22.


Although additional steps are needed to bridge the gap created by those who serve and those who have not, providing support for veterans to integrate back into their families and communities requires robust public-private partnerships. The veterans and the communities they live in are both responsible for bridging these gaps.


The challenges of adjustment to transition, post-traumatic stress (PTSD), traumatic brain injuries (TBI), and physical disabilities need to be addressed mainly as these things result in barriers in education, health care, employment, and overall individual well-being. Overall, the majority of these needs are being met by combining different veteran-serving nonprofits and VA support; however, many veterans do not know how to navigate this process. Unfortunately, there are still visible gaps in the system.


The veteran advocacy community needs to tailor our programs, especially in preventing suicides, to respond to this concerning data. One suicide is one suicide too many. Effective programs to help service members, veterans, and families transition to a positive life after service are necessary.


Another requirement is promoting supportive community relationships for veterans. We need to be developing programs specifically to address veterans’ needs while maintaining preventative care for recently returned veterans.


As veterans, we all pride ourselves on not making an emotional decision but the right decision. We should have the same commitment with veterans, which means we need to act within the framework of facts — advocacy and programming. Inadvertently, we are preying on a well-intentioned public by citing a misleading statistic to receive financial support, and that is not right.


As veterans, we are far more resilient than we give ourselves credit. If we do our jobs and extend a helping hand to our fellow veterans, we can reduce that suicide rate and ensure our fellow veterans avoid despair in the future.


Screening and Evaluation Expansion


The VA started a universal screening for suicide risk in all primary-care settings beginning in October 2018 and has conducted over 3.8 million veteran screenings for suicide. The screening protocol has three parts: The first part consists of primary screening for suicide risk using the Patient Health Questionnaire-9, typically conducted by a registered nurse. If that screening indicates a positive result, the nurse will handoff the veteran to the primary-care provider to conduct a secondary screening utilizing the Columbia-Suicide Severity Rating Scale. If that screening is positive, then a comprehensive suicide risk evaluation is conducted by the primary care provider.


Another strategy deployed by the VA to help identify veterans at risk is REACH VET, a computer-based statistical risk algorithm that flags veterans based on their electronic health records. The program aims to identify and allow for preemptive care and support for veterans, usually before an individual even develops suicidal thoughts. Once a veteran has been recognized by REACH VET, the veteran’s VA mental health specialist calls to check up on them and conduct an additional evaluation to help determine any enhanced care is needed.


Promising interventions


After veterans at risk for suicide have been identified, the next step is to offer effective interventions. Over the past ten years, researchers have found that cognitive-behavioral therapy (CBT) can reduce suicidal thoughts and behavior for veterans at risk. But limitations of these psychotherapy approaches is that they require multiple sessions and are not easily implemented.


To get more direct care to these patients, a 20- to 40­-minute intervention called the Safety Planning Intervention, designed to provide veterans with different coping strategies, reduce access to potential suicide methods like firearms and lethal medications, and help them establish follow-up treatment.

The research found that veterans who received this intervention were 45 percent less likely to attempt suicide with a safety plan in place for veterans.


Other promising VA suicide prevention interventions focus on technology to help patients at risk for suicide. A smartphone app has shown success in increasing the veterans’ coping abilities with unpleasant thoughts and emotions. The Virtual Hope Box app is modeled after CBT methodology that uses a physical box containing images that remind patients of positive experiences, people who care about them, reasons for living, or coping resources. Users can upload personal photos, videos, songs, and quotes; complete relaxation exercises, puzzles, and guided meditations; additional tools include coping mechanisms, including self-created cards and a phone contact list.


One of the essential aspects of suicide prevention among veterans is ensuring ongoing access to mental health care is available, particularly during transition times, when suicide risk can be higher. A unique way the military is working to ensure veterans have constant access to quality mental health care through its inTransition program, which offers expert coaching and assistance to find a new mental health provider for veterans. The program was created to ensure a good handoff between mental health providers when veterans are transitioning.


During the initial months after separation from the military, there is an increased risk to psychological health. That is why inTransition targets service members receiving psychological care in the 12 months before their military transition. All veterans are eligible for the program, and inTransition will find any local veteran care, even in the absence of VA. Even though the program is new, results are beginning to show successful increases in the veteran transition to new mental health providers.


Focusing on lethal means safety


While much of the VA’s efforts around preventing suicide focus on identifying and treating mental health issues, some experts point to the preventative measure surrounding firearms. Research shows that around 70% of military suicides involve firearms, compared with approximately 50% of suicides in the U.S. general population.


The military is more likely to own firearms and knows how to use them and that they are more likely to use firearms for the purpose of suicidal behavior as compared with the general population


An example can be shown that the firearm storage practices of more than 1,600 active-duty personnel from 2015 and 2018 at military primary-care facilities across the U.S. They found that nearly 36% of participants reported owning a firearm, but less than a third of those said their firearms were safely stored. About half indicated their firearms were not safely stored. More effort is needed to encourage veterans to keep their firearms safely. Findings from nonmilitary populations suggest this is an additional way to reduce suicide risk.


Locking up a gun will not prevent an argument with a spouse or overwhelming stress, but it could reduce the likelihood of these circumstances resulting in death.


The Veterans Health Administration is educating clinicians about the importance of asking veterans about firearms and whether they are safely stored, educating veterans about having friends restrict their firearms access during stressful times.


Using communities as support


Psychologists are looking for ways to prevent military suicides by looking for outside of military solutions. According to the 2019 National Veteran Suicide Prevention Annual Report, the suicide rate of veterans receiving recent VA care increased by 1.3%, while the suicide rate among veterans who were not receiving current VA care increased by 11.8%.


Another effort to provide a greater understanding of the role that communities play in their prevention of suicide is Operation Deep Dive. The study examines the community-based factors involved in suicide among veterans. It has developed a “sociocultural death investigation” tool to be used by researchers to conduct interviews with family members, colleagues, and friends of deceased veterans to better understand the lives of veterans who recently died by suicide. The goal is to identify the opportunities of prevention before a veteran enters any suicide situation.


Operation Deep Dive ultimately looks to where the community might have prevention points to divert an individual on the trajectory to suicidal death.


Hopefully this information has increased your knowledge on this serious social issue. If you a veteran in need or you know of a veteran who needs help please use the information below to help them.


Veterans experiencing any mental health emergency should contact the Veteran Crisis Line at 1-800-273-8255 and select option 1 for VA staff personnel. Veterans or their family members can also text 838255 or visit VeteransCrisisLine.net for assistance.


References:


Bare, S. (2015). The Truth About 22 Veteran Suicides A Day. Task and Purpose. Retrieved From

https://taskandpurpose.com/support/truth-22-veteran-suicides-day/


Novotney, A. (2020). Stopping military and veteran suicides. American Psychological Association (APA). Retrieved from https://www.apa.org/monitor/2020/01/ce-corner-suicide


Shane, L. (2020). Suicide Rate Among Veterans Up Again Slightly Despite Focus on Prevention Efforts. Military Times. Retrieved from https://www.militarytimes.com/news/pentagon-congress/2020/11/12/suicide-rate-among-veterans-up-again-slightly-despite-focus-on-prevention-efforts/

Image provided by Bare, S. (2015). The Truth About 22 Veteran Suicides A Day. Task and Purpose. Retrieved From

https://taskandpurpose.com/support/truth-22-veteran-suicides-day/

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