VA Suicides: When did it become Ethical to do nothing?

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Many would agree that one of the most disturbing trends regarding veterans and mental health has been the rising number of suicides.   What is more troubling is that the Department of Defense (DOD), Veterans Administration (VA) and the US Senate and Congress have consistently acknowledged the suicides of veterans as a serious issue for the past 7 years, and, with the exception of the latest VA mental health hiring initiative, have done very little to address the rising trends.  The most disconcerting actions for me are when Senators and Representatives of Congress rally around a high profile veteran’s death by suicide.  I’m not sure a month has passed in the last 5 years where there was a news story about a veteran’s suicide in some area of the country that did not provoke one or more local representatives of the United States legislature into using the tragedy as an opportunity to investigate and acknowledge the issue.

From 2010 to 2012 the number of reported deaths by suicide for our veterans was consistently 22 deaths every day.  Reports in 2009 indicated 18 veterans a day were dying by suicide.  One of the more recent reporting trends has been veterans completing suicide within the walls of VA facilities.  There are other elements within other reported findings that shed some light on the possible root causes of this disturbing trend.  A major indicator may be that amongst veterans enrolled in VA Health services, 80% of the reported suicide attempts occur within a month of seeking VA mental health services.  What is inconsistent is the actual numbers on how many veterans requesting mental health services received initial evaluations within 24 hours as required by Federal law. There are reports of some veterans waiting as long as two months for such evaluations.  This is unacceptable.  Another key indicator is the highly recognized situation that only 15% of veterans diagnosed with PTSD obtain the minimum of eight psychotherapy treatments within a fourteen week period.

What should be of great concern is the amount of information going unanalyzed or unreported.   Some of the obvious questions from the current information include:  Why are only 56% of the eligible 1.6 million veterans of OEF/OIF/OND registering for VA health care?  How many unregistered OEF/OIF/OND veterans have exhausted their five year eligibility window of free VA Healthcare? Are they actively employed, imprisoned or homeless?  There are other reports indicating that a majority of the veteran’s dying by suicide are over the age of 50.  If this is true, then are the current trends in veteran suicides connected to unrecognized mental health problems or misdiagnosed medical issues such as traumatic brain injury (TBI)?  TBI was an almost non-existent diagnosis prior to 1993.  Most of the articles on veteran suicide are centric to Post Traumatic Stress Disorder and are derived from statistics internal to the VA.  Sixty-One percent (13.4 million) of all veterans are not under VA care, of which 5 million are believed to have service-connected disabilities and suicide risk behaviors not reflected of the numbers being reported.  Of this number are over 700,000 Post 9/11 veterans.  What are the exact correlations to mental health and physical health problems and veteran suicides?  What are the real numbers when it comes to veteran suicides?

The VA is in the process of completing a two month outreach effort to community resources under their VA Mental Health Summit initiative. I have personally attending seven of the VA Mental Health summits across the Midwest where a number of potential solutions on how to work with the at risk veteran population were presented.  One of my concerns is the strict VHA guidelines for utilizing only CARF accredited providers as community outreach providers under new VA initiatives.  Having case-managed and counseled hundreds of veterans with TBI, PTSD, housing challenges, as well as incarcerated veterans, I can tell you the “Elephant in the Room” is actually a herd.  There are rising issues with the severe and moderate TBI veterans that will require services not offered by many of the CARF accredited providers.  There are community providers already working under standards such as the Joint Commission on Accreditation of Healthcare Organization (JCAHO) with the expertise to support the gaps in care.   Reaching a majority of the five million at risk veterans not currently in the VA health system will require partnering with agencies with the ability to meet the veteran where they currently live mentally, physically and socially.  Community Action Agencies, who are already working with the fall-outs of homelessness, family assistance and countless other outreach efforts to support veterans in crisis and their families, are important allies in reaching out to the unidentified veterans.

There are many unknowns and misinformation surrounding this issue. Unfortunately, the indications are that the numbers are greatly underestimated.  At times, I wonder whether the failure to move forward is centered on “Analysis Paralysis”, fear of the unknown, or the opportunity of a photo-shoot. On March 5th, 2013 some in Congress questioned how many of the suicides were related to TBI.  Based on the VA numbers, we have lost over 4500 veterans to suicide since Congress once again cited this as another VA Mental Health epidemic.  Where would we be as a nation if we sent our brave men and women into combat and instructed them to do nothing?

 

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