By Sandra Basu
WASHINGTON-Advocacy groups were upset last month that a bill requiring VA and DoD to conduct annual evaluations of their mental healthcare and suicide prevention programs was not passed before Congress finished its business in December.
The bill, the Clay Hunt Suicide Prevention for American Veterans (SAV) Act, had broad support among many lawmakers and was passed by the House of Representatives. It failed to be voted on in the Senate, however, after Sen. Tom Coburn (R-Okla.) put a hold on the $22 million bill, which prevented it from receiving a vote in the Senate.
The bill is named for Clay Hunt, a Marine veteran who took his own life in 2011 after serving in both Iraq and Afghanistan. Coburn, who is leaving the Senate, said he opposed the bill because it duplicated existing programs and was not funded by offsets in the budget.
In addition to directing the review of DoD mental health and suicide prevention programs, the bill also requires a review of the terms of the discharge or separation of certain individuals from the military and also requires a pilot program on loan repayment for psychiatrists who agree to work at the VA.
Hours before the Senate was set to leave Washington, advocacy groups were pushing for a vote of the highly publicized bill.
“The bill we are talking about is projected to cost about $22 million dollars. That’s a lot of money to me. It’s a lot of money to you. But in the context of the value of a human life, it is insignificant,” Richard Selke, Hunt’s stepfather, said in a statement directed to Coburn.
Mental Health Programs
The issue of how VA is using resources to address mental health has been one that lawmakers have repeatedly questioned. At a hearing held by the Senate Committee on Veterans’ Affairs in late November, VHA Chief Mental Health Consultant Harold Kudler, MD, said that, as of April 2014, VHA has 21,158 mental health full-time equivalent employees providing direct inpatient and outpatient mental health care.
He also told lawmkers that VA has expanded access to mental health services with longer clinic hours, telemental heath capability to deliver services, as well as standards that mandate immediate access to mental health services to veterans in crisis.
“The number of veterans receiving specialized mental health treatment from VA has risen each year from over 900,000 in FY 2006 to more than 1.4 million in FY 2013. During that same period, our mental health outpatient staff grew from 7,000 to over 13,000,” he said.
When it comes to suicide, Kudler said that mortality rates among those who use VHA services has remained stable at a range from 35.5 to 37.5 per 100,000 persons per year over the past four years. At the same time, he explained, rates of suicide among middle-aged adults who use VHA services decreased by more than 16% between the years 1999-2010.
VA officials also acknowledged that suicides among women who use VHA services have increased but could only speculate as to why.
“We know that women veterans are using firearms at an increased rate than women nonveterans. We know that, if you use a firearm when you are suicidal, there is a 90% chance that you will die. If you use prescription medications, which is what most women nonveterans use, there is a 3 to 4% chance you will die, because there is that opportunity to reach them before they die,” Deputy Director of VHA Suicide Prevention Caitlin Thompson, PhD, testified.
Sen. Patty Murray (D-WA) suggested that VA needed to look at whether the agency is meeting women’s needs and why the suicidal rate for women is increasing.
“Are the programs not effective? Are they not feeling they should ask about it? Is it something else? This is really concerning to me,” she said at the hearing.
At that same hearing, Susan Selke, Hunt’s mother, told lawmakers that her son sought mental health care at VA but found the environment to be highly stressful.
“Despite his proactive and open approach to seeking care to address his injuries, the VA system did not adequately address his needs,” Selke recounted. “Even today, we continue to hear about both individual and systemic failures by the VA to provide adequate care and address the needs of veterans.”
According to Selke, “the reforms, evaluations and programs” directed by the bill named for her son “will be critical to helping the VA better serve and treat veterans suffering from mental injuries from war.”
Also testifying was Elspeth Cameron Ritchie, MD, MPH, U.S. Army (Ret.), a member of the Institute of Medicine Committee on the Assessment of Ongoing Efforts in the Treatment of PTSD and a Georgetown University clinical professor of psychiatry. Almost nothing is known about what precipitates self-injury among veterans, as compared with suicides among active duty military, she pointed out, adding, “There needs to be more resources in the VA to learn who is suiciding.”
She also recommended that veterans should be better screened for exposures to a number of potentially toxic agents, including Mefloquine (an antimalarial), which she said has been associated with psychiatric symptoms and suicide.
“Fifty years after the beginning of the Vietnam War and 23 years after the first Gulf War and the so-called Gulf War illness, the military has dramatically stepped up their screening as troops re-deploy home. But this is not yet uniformly done in the VA,” she said in a written statement.