Nearly 50,000 veterans used free emergency suicide prevention in first year of program, VA says

K. Watson and S. Cook

CBS News

Originally posted 17 Jan 24

Here is an excerpt:

A 2021 Brown University study estimated that more than 30,000 veterans of post-9/11 conflicts have died by suicide, more than four times the 7,057 U.S. military personnel killed at the time in those conflicts. 

And the veteran suicide rate has outpaced the rate of the general U.S. public. A 2023 report by the Department of Veterans Affairs found that in 2021, the suicide rate for veterans was 71.8% higher than non-veterans when adjusted for age and sex differences.

That same report found that 6,392 veterans died by suicide in 2021, an average of more than 17 veterans taking their lives every day.

In November 2021, the Biden administration released a new national strategy to reduce military and veteran suicide, calling it a "public health and national security crisis."

"I've often said that we have only one truly sacred obligation as Americans—to prepare and properly equip our women and men in uniform when we send them into harm's way, and to care for them and their families when they return," President Biden wrote in the introduction to the strategy document. "Yet for too many who are serving or have served, we are falling short."

The info is here.

Key points:

49,714 veterans accessed the program: This translates to over $64 million saved in healthcare costs.

Program covers: Emergency room care, inpatient/crisis residential care for up to 30 days, and outpatient care for up to 90 days.

Accessibility: Veterans don't need to be enrolled in the VA system to qualify.

Suicide Has Been Deadlier Than Combat for the Military

Carol Giacomo
The New York Times
Originally published November 1, 2019

Here are two excerpts:

The data for veterans is also alarming.

In 2016, veterans were one and a half times more likely to kill themselves than people who hadn’t served in the military, according to the House Committee on Oversight and Reform.

Among those ages 18 to 34, the rate went up nearly 80 percent from 2005 to 2016.

The risk nearly doubles in the first year after a veteran leaves active duty, experts say.

The Pentagon this year also reported on military families, estimating that in 2017 there were 186 suicide deaths among military spouses and dependents.

(cut)

Experts say suicides are complex, resulting from many factors, notably impulsive decisions with little warning. Pentagon officials say a majority of service members who die by suicide do not have mental illness. While combat is undoubtedly high stress, there are conflicting views on whether deployments increase risk.

Where there seems to be consensus is that high-quality health care and keeping weapons out of the hands of people in distress can make a positive difference.

Studies show that the Department of Veterans Affairs provides high-quality care, and its Veterans Crisis Line “surpasses most crisis lines” operating today, according to Terri Tanielian, a researcher with the RAND Corporation. (The Veterans Crisis Line is staffed 24/7 at 800-273-8255, press 1. Services also are available online or by texting 838255.)

But Veterans Affairs often can’t accommodate all those needing help, resulting in patients being sent to community-based mental health professionals who lack the training to deal with service members.

The info is here.

Suicide rates climbing, especially in rural America

Misti Crane
Ohio State News
Originally published September 6, 2019

Suicide is becoming more common in America, an increase most pronounced in rural areas, new research has found.

The study, which appears online today (Sept. 6, 2019) in the journal JAMA Network Open, also highlights a cluster of factors, including lack of insurance and the prevalence of gun shops, that are associated with high suicide rates.

Researchers at The Ohio State University evaluated national suicide data from 1999 to 2016, and provided a county-by-county national picture of the suicide toll among adults. Suicide rates jumped 41 percent, from a median of 15 per 100,000 county residents in the first part of the study to 21.2 per 100,000 in the last three years of the analysis. Suicide rates were highest in less-populous counties and in areas where people have lower incomes and fewer resources. From 2014 through 2016, suicide rates were 17.6 per 100,000 in large metropolitan counties compared with 22 per 100,000 in rural counties.

In urban areas, counties with more gun shops tended to have higher suicide rates. Counties with the highest suicide rates were mostly in Western states, including Colorado, New Mexico, Utah and Wyoming; in Appalachian states including Kentucky, Virginia and West Virginia; and in the Ozarks, including Arkansas and Missouri.

The info is here.

The Parking Lot Suicide

Emily Wax-Thibodeaux.
The Washington Post
Originally published February 11, 2019

Here is an excerpt:

Miller was suffering from post-traumatic stress disorder and suicidal thoughts when he checked into the Minneapolis Department of Veterans Affairs hospital in February 2018. After spending four days in the mental-health unit, Miller walked to his truck in VA’s parking lot and shot himself in the very place he went to find help.

“The fact that my brother, Justin, never left the VA parking lot — it’s infuriating,” said Harrington, 37. “He did the right thing; he went in for help. I just can’t get my head around it.”

A federal investigation into Miller’s death found that the Minneapolis VA made multiple errors: not scheduling a follow-up appointment, failing to communicate with his family about the treatment plan and inadequately assessing his access to firearms.

Several days after his death, Miller’s parents received a package from the Department of Veterans Affairs — bottles of antidepressants and sleep aids prescribed to Miller.

His death is among 19 suicides that occurred on VA campuses from October 2017 to November 2018, seven of them in parking lots, according to the Department of Veterans Affairs.

While studies show that every suicide is highly complex — influenced by genetics, financial uncertainty, relationship loss and other factors — mental-health experts worry that veterans taking their lives on VA property has become a desperate form of protest against a system that some veterans feel hasn’t helped them.

The most recent parking lot suicide occurred weeks before Christmas in St. Petersburg, Fla. Marine Col. Jim Turner, 55, dressed in his uniform blues and medals, sat on top of his military and VA records and killed himself with a rifle outside the Bay Pines Department of Veterans Affairs.

“I bet if you look at the 22 suicides a day you will see VA screwed up in 90%,” Turner wrote in a note investigators found near his body.

The info is here.

Moral Injury and Religiosity in US Veterans With Posttraumatic Stress Disorder Symptoms

Harold Koenig and others
The Journal of Nervous and Mental Disease: February 28, 2018

Abstract

Moral injury (MI) involves feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs related to traumatic experiences. This multisite cross-sectional study examined the association between religious involvement (RI) and MI symptoms, mediators of the relationship, and the modifying effects of posttraumatic stress disorder (PTSD) severity in 373 US veterans with PTSD symptoms who served in a combat theater. Assessed were demographic, military, religious, physical, social, behavioral, and psychological characteristics using standard measures of RI, MI symptoms, PTSD, depression, and anxiety. MI was widespread, with over 90% reporting high levels of at least one MI symptom and the majority reporting at least five symptoms or more. In the overall sample, religiosity was inversely related to MI in bivariate analyses (r = −0.25, p < 0.0001) and multivariate analyses (B = −0.40, p = 0.001); however, this relationship was present only among veterans with severe PTSD (B = −0.65, p = 0.0003). These findings have relevance for the care of veterans with PTSD.

The paper is here.

VA About To Scrap Ethics Law That Helps Safeguards Veterans From Predatory For-Profit Colleges

Adam Linehan
Task and Purpose
Originally posted October 2, 2017

An ethics law that prohibits Department of Veterans Affairs employees from receiving money or owning a stake in for-profit colleges that rake in millions in G.I. Bill tuition has “illogical and unintended consequences,” according to VA, which is pushing to suspend the 50-year-old statute.

But veteran advocacy groups say suspending the law would make it easier for the for-profit education industry to exploit its biggest cash cow: veterans. 

In a proposal published in the Federal Register on Sept. 14, VA claims that the statute — which, according to The New York Times, was enacted following a string of scandals involving the for-profit education industry — is redundant due to the other conflict-of-interest laws that apply to all federal employees and provide sufficient safeguards.

Critics of the proposal, however, say that the statute provides additional regulations that protect against abuse and provide more transparency. 

“The statute is one of many important bipartisan reforms Congress implemented to protect G.I. Bill benefits from waste, fraud, and abuse,” William Hubbard, Student Veterans of America’s vice president of government affairs, said in an email to Task & Purpose. “A thoughtful and robust public conservation should be had to ensure that the interests of student veterans is the top of the priority list.”

The article is here.

Editor's Note: The swamp continues to grow under the current administration.

Exploring the Association between Exposure to Suicide and Suicide Risk among Military Service Members and Veterans

Melanie A. Homa, Ian H. Stanley, Peter M. Gutierrezb, Thomas E. Joiner
Journal of Affective Disorders

Background

Past research suggests that suicide has a profound impact on surviving family members and friends; yet, little is known about experiences with suicide bereavement among military populations. This study aimed to characterize experiences with suicide exposure and their associations with lifetime and current psychiatric symptoms among military service members and veterans

Methods

A sample of 1,753 United States military service members and veterans completed self-report questionnaires assessing experiences with suicide exposure, lifetime history of suicidal thoughts and behaviors, current suicidal symptoms, and perceived likelihood of making a future suicide attempt

Results

The majority of participants (57.3%) reported knowing someone who had died by suicide, and of these individuals, most (53.1%) reported having lost a friend to suicide. Chi-square tests, one-way ANOVAs, and logistic regression analyses revealed that those who reported knowing a suicide decedent were more likely to report more severe current suicidal symptoms and a history of suicidal thoughts and behaviors compared to those who did not know a suicide decedent. Hierarchical linear regression analyses indicated that greater self-reported interpersonal closeness to a suicide decedent predicted greater self-reported likelihood of a future suicide attempt, even after controlling for current suicidal symptoms and prior suicidal thoughts and behaviors

Limitations

This study utilized cross-sectional data, and information regarding degree of exposure to suicide was not collected

Conclusions

Military personnel and veterans who have been bereaved by suicide may themselves be at elevated risk for suicidal thoughts and behaviors. Additional work is needed to delineate the relationship between these experiences.

The article is here.

Moral Injury Is The 'Signature Wound' Of Today's Veterans

Interview with David Wood
NPR
Originally posted November 11, 2014

Here is an excerpt:

On the best therapy for treating this "bruise on the soul"

The biggest thing that [the veterans] told me was that they're carrying around this horrible idea that they are bad people because they've done something bad and they can't ever tell anybody about it — or they don't dare tell anybody about it — and may not even be able to admit it to themselves.

One of the most healing things they have found is to stand in a group of fellow veterans and say, "This is what happened. This is what I saw. This is what I did," and to have their fellow veterans nod and say, "I hear you. I hear you." And just accept it, without saying, "Well, you couldn't help it," or, "You're really a good person at heart."

But just hearing it and accepting it — and not being blamed or castigated for whatever it was that you're feeling bad about. It's that validating kind of listening that is so important to all the therapies that I've seen.

The entire article is here.

As Suicides Rise in U.S., Veterans Are Less of Total

By JAMES DAO
The New York Times
Published: February 1, 2013

Suicides among military veterans, though up slightly in recent years, account for a shrinking percentage of the nation’s total number of suicides — a result of steadily rising numbers of suicides in the general population, according to a report released on Friday by the Department of Veterans Affairs.

The report, based on the most extensive data the department has ever collected on suicide, found that the number of suicides among veterans reached 22 a day in 2010, the most recent year available.

That was up by 22 percent from 2007, when the daily number was 18. But it is only 10 percent higher than in 1999, according to the report. Department officials described the numbers as “relatively stable” over the decade.

In the same 12-year period, the total number of suicides in the country rose steadily to an estimated 105 a day in 2010, up from 80 in 1999, a 31 percent increase.

As a result, the percentage of the nation’s daily suicides committed by veterans declined to 21 percent in 2010, from 25 percent in 1999.

The entire story is here.

VA report: 22 veterans commit suicide each day

The number of veterans who commit suicide each day is more than 20 percent higher than previously estimated
 

By Kevin Freking

Salon.com
Originally published February 1, 2013

The number of veterans who commit suicide each day is more than 20 percent higher than the Department of Veterans Affairs has previously estimated, but the problem doesn’t appear to be getting worse for veterans compared to the rest of the country, according to a VA study released Friday.

Indeed, the overall percentage of suicides by veterans has declined in recent years. VA researchers say the trend suggests that efforts to reduce suicide among veterans may be having an effect.

About 22 veterans committed suicide each day in 2010. Previous estimates from the VA put the number at 18.

While much attention has been paid to suicides by veterans of Iraq and Afghanistan, the report indicates the problem is worse among older veterans. About 70 percent of veterans who commit suicide are over age 50.

The latest projections from the VA incorporate data from about two dozen states that recorded the cause of death on death certificates. Previous estimates focused only on those getting care from the VA’s hospitals and clinics. The department described the study as the most comprehensive it has ever taken on the issue. 

“We have more work to do, and we will use this data to continue to strengthen our suicide prevention efforts and ensure all veterans receive the care they have earned and deserve,” said VA Secretary Eric K. Shinseki.

Tending to Veterans’ Afflictions of the Soul

By Samuel J. Freedman
The New York Times
Originally published January 13, 2013

Here are some excerpts:

Moral injury might best be defined as an affliction of the soul, as distinct from a specific mental health condition like post-traumatic stress disorder. It arises, to speak in a very broad way, from the way a combatant’s actions in war seem to violate and thus undermine the most deeply held moral beliefs.

Ms. Brock did not formulate the concept of moral injury, which is attributed to the clinical psychiatrist Jonathan Shay. In books like “Achilles in Vietnam,” Dr. Shay has traced moral injury back as far as the Trojan War. But for Ms. Brock and her colleagues, the kind of counterinsurgency wars America has fought in Iraq and Afghanistan has left soldiers uniquely vulnerable to moral injury.

“There’s no good choice,” she said. “If you’re looking at a kid on the side of the road with something in his hand, if it’s a grenade and he throws it and kills someone in your unit, you’ve failed your comrade. But if it’s a rock, you’ve just shot a kid with a rock.
“If you’re praying that your company gets out or that your best friend isn’t shot, and it doesn’t turn out that way, it can collapse your whole moral system. It feels like God abandoned you.”

Her description closely matched that of Michael Yandell, 28, a student at the Brite seminary who worked on a bomb disposal team during the Iraq war. “Most deeply, it’s a loss of confidence in one’s own ability to make a moral judgment with any certainty,” he said. “It’s not that you lose your ability to tell right from wrong, but things don’t seem so clear any more. For me, it’s whether or not what I did, did any good.”

Ms. Brock’s affinity for veterans, and her knowledge of their suffering, has long, deep roots. Her father, Roy Brock, was taken prisoner during World War II and underwent electroshock treatments after liberation for his psychological distress. He later served two tours in Vietnam as a medic, enduring the deaths not only of countless soldiers but the local translator he had befriended.

The entire story is here.

Telephone therapy technique brings more Iraq and Afghanistan veterans into mental health treatment

Medicalxpress.com

Originally published July 26, 2012

A brief therapeutic intervention called motivational interviewing, administered over the telephone, was significantly more effective than a simple "check-in" call in getting Iraq and Afghanistan war veterans with mental health diagnoses to begin treatment for their conditions, in a study led by a physician at the San Francisco VA Medical Center and the University of California, San Francisco.

Participants receiving telephone motivational interviewing also were significantly more likely to stay in therapy, and reported reductions in marijuana use and a decreased sense of stigma associated with mental health treatment.

The study was published electronically recently in General Hospital Psychiatry (May 25, 2012).

Lead author Karen Seal, MD, MPH, director of the Integrated Care Clinic at SFVAMC and an associate professor of medicine and psychiatry at UCSF, noted that 52 percent of the approximately half-million Iraq and Afghanistan veterans currently being seen by the VA have one or more mental health diagnoses, including post-traumatic stress disorder, depression, anxiety or other related conditions.

The entire story is here.

Vets face shortage of therapists

New program training clinicians in psychology of combat is an attempt to help fill the gap

By Peter Cameron, Special to the Tribune

When Daniel Brautigam tried to tell therapists how he felt having urine thrown in his face at Guantanamo Bay, he experienced the same frustration as thousands of other returning veterans who have sought counseling.

"They had no idea how to respond to that. It looked like to me that they were grossed out, and they're supposed to be helping me," said Brautigam, 31, who was diagnosed with post-traumatic stress disorder and depression following his return to Hoffman Estates from tours with the Navy in the Northern Arabian Gulf and Cuba.

The Department of Veterans Affairs estimates that 11 percent to 20 percent of veterans from the wars in Afghanistan and Iraq are suffering from PTSD. Others think the number is higher.
When vets seek therapy, they want a professional who can relate to soldiers in combat, and that usually means a therapist who has military experience. Without such empathy, therapy often is doomed, vets say.

Because most psychologists and mental health care professionals don't have a military background, there's a void in the safety net for vets. Some veterans' organizations have stepped up, training members to help their peers, and the Soldiers Project provides free counseling from licensed professionals and veterans by phone to newly returned vets.

A counselor to ex-soldiers for 35 years, Ray Parrish, 58, a self-described angry veteran, sees the problem on a daily basis. He is the benefits director for Vietnam Veterans Against the War in Chicago and helps those trying to navigate the bureaucracy of the Veterans Administration.

"There quite literally are not enough people that have knowledge of veterans' experiences and who have the professional expertise to provide them the health that they need," Parrish said. "That means that all of the veterans get inadequate care."

A new attempt to fill the gap is coming from the Adler School of Professional Psychology in Chicago, which this fall is launching a military specialization track for its doctorate of clinical psychology program. Joe Troiani, a faculty member and Navy veteran who created the track, said the school hopes to prepare students for the specific psychological problems that stem from military service. They will take such classes as the psychology of terrorism, and psychology of combat and conflict.

But some vets scoff at the idea of learning about the horrors of war in the classroom.

"You're dealing with a whole different mindset with a soldier," said Tim Miller, 30, of Chicago, a veteran of the Iraq war who is now studying to be a clinical psychologist at Argosy University. "You can't just wrap your head around that from reading a book."

Troiani called that criticism fair but said the school is training students how to treat the psychological effects of combat, rather than trying to re-create the experience of living in a war zone.

Read the story here.

A War Inside: Saving Veterans from Suicide

From Penn Medicine

PHILADELPHIA — An estimated 18 American military veterans take their own lives every day -- thousands each year -- and those numbers are steadily increasing. Even after weathering the stresses of military life and the terrors of combat, these soldiers find themselves overwhelmed by the transition back into civilian life. Many have already survived one suicide attempt, but never received the extra help and support they needed, with tragic results. A team of researchers from the Perelman School of Medicine at the University of Pennsylvania and colleagues found that veterans who are repeat suicide attempters suffer significantly greater mortality rates due to suicide compared to both military and civilian peers. The research was published this month in BMC Public Health.

The study is the largest follow-up of suicide attempters in any group in the United States, and is unique even among the relatively few studies on veteran suicide: "We looked at suicide among veterans who had already attempted suicide one time," notes study author Douglas J. Wiebe, PhD, assistant professor of Epidemiology. The findings, he says, "should have us very concerned about current veterans in the more contemporary era."

Wiebe, along with Janet Weiner of Penn's Leonard Davis Institute of Health Economics and Therese S. Richmond of the School of Nursing, teamed with Joseph Conigliaro of the New York University School of Medicine to conduct a study of military veterans who received inpatient treatment at a Department of Veterans Affairs (VA) medical center for a suicide attempt between 1993 and 1998. Using additional data from the VA, as well as the National Center of Health Statistics, these veterans were followed for incidence, rate, and cause of mortality through the end of 2002.

Among the total of 10,163 veterans treated for a suicide attempt between 1993-1998, 1,836 died during the follow-up period through 2002, with heart disease, cancer, accidents, and suicide accounting for over 57% of those deaths. Suicide, however, was the second- leading cause of death among the male veterans, and the leading cause among females, accounting for just over 13% of all the deaths in the study cohort. In comparison, suicide accounted for only 1.8% of deaths in the general U.S. population during those years.

Wiebe and his colleagues discovered that veterans who have attempted suicide not only have an elevated risk of further suicide attempts, but face mortality risks from all causes at a rate three times greater than the general population. The so-called "healthy soldier effect," that military personnel should be healthier than an average person of the same sex and age because they have passed military fitness requirements, does not protect veterans from death from chronic disease, and does not appear to mitigate their risk of suicide. "The 'healthy soldier effect' is no reason to think that veterans should be more emotionally and mentally resilient than anyone else," says Wiebe. "The consequences of military service can include both physical and emotional health challenges that veterans continue to face long after their 'war' is no longer on the front page."

The current study strongly emphasizes the increased need for more intensive and vigorous efforts to identify and support veterans who are at risk, especially those who have already actually attempted suicide, say the authors. With military personnel now facing combat in numbers not seen since the Vietnam War, developing better strategies for suicide prevention is more important than ever. "Almost all of today's soldiers are seeing combat and repeated tours, so that could be a reason to be even more concerned about veteran populations in the years moving forward," Wiebe says.

Wiebe's next step is to analyze the collected data to identify more specific risk factors for suicide or other premature causes of death. Although he argues that "we need to be more tuned into this problem in America in general," he is hopeful that examples of successful suicide prevention programs, particularly one conducted by the U.S. Air Force, could provide an inspiration and foundation for new efforts. "A major part of the success of that program was just changing the climate around how people think and talk about suicide," he says. "There's evidence out there to suggest that could work among veterans too. The time to get started is now."