Suicide Rate Drops but Veterans Still Struggle to Get Mental Health Care

by U.S. Medicine

January 10, 2012

WASHINGTON — Reports about suicide prevention constantly focus on the difficulty veterans have in receiving mental healthcare, even though the suicide rate is dropping.

In fact, there is little disagreement that the suicide threat is greatly diminished in veterans who receive the full course of treatment at VA, which is making significant advancements in treatment modalities.


Suicide Prevention responder Melissa Schwab (at keyboard) relies on health technicians to provide support while engaging a distressed Veteran. Suicide Prevention Hotline: 1-800-273-TALK.

So, where’s the disconnect?

Some possible answers were revealed at a recent House VA committee hearing.

The directives made at the national level are not always applied fully or consistently at local VA facilities, veterans service organizations (VSO) representatives told legislators.

Cdr. Rene Campos, USN (Ret.), deputy director of the Military Officers Association of America (MO), praised VA and DoD for their suicide-prevention efforts and lauded VA Secretary Eric Shinseki for making it such a high priority.

Campos pointed out, however, that efforts seen on the national level do not always make their way to the field.

“One caregiver spouse of a veteran with PTSD said it took the VA two months to schedule an appointment just to get a fee-based referral for her husband, who has trouble sleeping. Now he must wait until May 2012 for the VA to do a required sleep study,” Campos said. “Difficulty sleeping is a risk factor, and her husband has a history of suicide attempts.”

This can be the result when VA facilities try to respond to nationwide initiatives yet lose focus on individual veteran needs by not responding intelligently to those veterans most at risk, Campos said.

“There’s so much focus at the medical-facility level at getting people seen that it’s become an assembly-line process. It’s creating havoc in the system,” she said. “And you have the pockets where there aren’t enough resources or staffing or infrastructure. The system is overwhelmed.”

A more unified suicide-prevention campaign by both VA and DoD could help ensure nationwide consistency, Campos said. MO is urging Congress to require VA and DoD to establish a single strategy and joint suicide prevention program — one that reports directly to the two agencies’ secretaries.

There’s also a lack of research on who is most at risk and on the impact of suicide on the nation. “We need a longitudinal study of the economic and societal costs of veteran suicide in this country,” she said.

Continuing Medication


Cdr. René A. Campos, USN (Ret.), deputy director, government relations for the Military Officers Association of America (MOAA) testifies at an earlier congressional hearing. Photo from MOAA website.

This inconsistency at VA facilities can result in veterans not receiving a full course of care to help prevent suicide.

Katherine Watkins, MD, senior natural scientist at the RAND Corp., testified about recent studies into the quality of VA behavioral healthcare that showed 60% of veterans who had contact with VA treatment services before committing suicide had been hospitalized for psychiatric reasons in the year before their death.

RAND researchers found that more than half of veterans studied who began medication treatment for depression and bipolar illness did not receive the recommended length of treatment. Also, more than two-thirds of those on maintenance treatment did not take their medications.

“VA needs to increase the proportion of veterans who receive the recommended length of pharmacotherapy,” Watkins said. “Taking medications consistently and for the recommended length of time is important for both depression and bipolar illness. Taking the recommended medication prevents suicide.”

She urged VA to adopt clinical registries that would allow physicians to track medication compliance, and she pointed out that setting up the system should require very little effort, considering VA’s use of an advanced computerized patient record system.

“Using this registry, you could see who isn’t compliant, and you could do outreach,” Watkins said. “VA has substantial capacity to deliver mental healthcare to veterans. [The agency] is just falling short of its own implicit expectations.”

Suicide Rate Drops but Veterans Still Struggle to Get Mental Health Care Cont.

Improving VA’s Image

VSO representatives also emphasized that, if VA expects to reach at-risk veterans, they need to do something about how they market their services.

“The VA has good programs, but nobody knows what the VA does. People barely know the VA exists,” said Tom Tarantino, senior legislator associate for the Iraq and Afghanistan Veterans of America (IAVA). “It drives me nuts each time the VA asks me how to reach out to veterans. I tell them to stop reaching out to veterans. Reach out to people. And stop asking me. Ask the people who know how to sell toothpaste.”

It will not always be veterans who come to VA seeking help for themselves, Tarantino said. Wives, other family members and friends often make the first contact. Any ad campaign focused exclusively on veterans will miss this demographic.

VA has taken those recommendations to heart, responded Jan Kemp, PhD, VA’s national mental health director for suicide prevention. “We’ve made huge strides in the past three years providing outreach to younger veterans,” Kemp said. “We realize they communicate differently. We’ve developed a veterans chat service, and just this month we opened a texting service, so people can text the crisis line. It’s having a remarkable response and going really well.”

“We’ve also rebranded the suicide hotline into the Veterans Crisis Line to better portray what we do and reach people. The results have been tremendous,” Kemp said.

VA also has contracted with a national advertising firm to develop message and marketing strategies. The department rolled out new public-service ads last month, targeting veterans at risk for suicide.

One, which was screened by legislators at the hearing, is considerably darker than previous campaigns. It shows a middle-aged veteran tossing and turning in bed, plagued by images of war. The other, considerably more upbeat, is targeted at Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) veterans.

Kemp did have some positive news to give the committee. CDC recently released data from 2009, which shows that the suicide rate among veterans in VA care is decreasing.

In FY 2009, there were 22 suicides among OEF/OIF veterans in VA care. The suicide rate in this group was 47.1 per 100,000. This compares to 32 suicides in FY2008 and a rate of 75.4 per 100,000.

For individuals with mental health or substance use disorder diagnoses, the suicide rate in FY2009 was 56.4 per 100,000, compared with 23.5 among patients without these diagnoses. This continues a steady trend of reducing that disparity. In FY2001, the suicide rate among patients with mental health or substance use disorder diagnoses was 78.0 as compared to 24.7 among patients without these diagnoses

“We’re making a difference,” Kemp said. “Those rates are going down in the group of patients who get mental healthcare in VA.”

Among veterans who do not receive care, however, the suicide rate remains the same, she added. “Veterans are still dying by suicide, which means we have more work to do.”

Veterans Crisis Line

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