Veterans & Suicide
Editor: I often hear the statement "Men kill themselves at four times the rate of women because they use more lethal means". The real question here is not that they use more lethal means, it's why they use more lethal means. Where's the discussion that it's based in cultural training? Starting with "Big boys don't cry", the discouragement, very intense in sports, deride a man who shows feelings (except anger) or vulnerability, or weakness. The constant message: handle it, deal with it, cowboy up and Lord knows, don't be a victim. The cultural training starts from the day men are born, preparing them for military combat where they may face another man and must be prepared to kill him. Men use lethal means because, unlike many women who use less lethal means in a cry out for help, men cannot fail. What would it feel like if they end up in the hospital and their buddies come in and say "You can't even do this right." I've often asked women's group how it would feel to be brought up all your life knowing that someday your country was going to ask you to kill other women? While women do serve in combat units elbow to elbow with men in many countries, it's just beginning to happen in the US Let's see if it changes the dynamics. - Gordon Clay Crisis, stress, depression, and other issues affect people in different ways. If you feel like you might be heading toward a crisis, treatment can help. Take a confidential, anonymous risk assessment to see how you might benefit from VA or community-based services.
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Frailty and
Suicide Risk Among Older Adult Veterans 6/2/23 Study participants were 2,858,876 veterans (mean age 75.4) who received care at U.S. Department of Veterans Affairs (VA) medical centers from October 1, 2011, through September 13, 2013. The sample population was 2.3% female and 97.7% male, 9.0% non-Hispanic Black, 87.8% non-Hispanic White, and 2.6% “other” or unknown ethnicity. Among all participants, 16.6% had diagnosed substance use disorder (SUD) and 6.8% had diagnosed post-traumatic stress disorder (PTSD). The study integrated databases from VA health care services, Centers for Medicare & Medicaid Services, and other national suicide data. Using suicide attempts through December 31, 2017, as the main outcome measure, researchers analyzed degree of frailty categorized into five levels (nonfrailty; prefrailty; and mild, moderate, and severe frailty). The researchers found that the risk of suicide attempts was higher in veterans with all levels of frailty compared to those without frailty. Risk of lethal suicide attempts was associated with lower levels of frailty. A total of 8,995 (0.3%) participants had a documented suicide attempt and 5,497 had died by suicide by the end of the study period. The greatest percentage of suicide attempts was found among those with mild or moderate frailty and the smallest percentage among those without frailty. Veterans with prefrailty had the highest cumulative incidence of fatal suicide attempts over time. The risk of any suicide attempt was 48% higher among older veterans with moderate frailty compared to veterans without frailty. The presence of chronic pain, use of durable medical equipment (e.g., motorized wheelchair), lung disease, SUD, PTSD, or other mental health disorder increased the risk of suicide attempts as well as deaths. The sample for this study was predominantly male (97.7%); women have only recently begun to enter the military in large numbers and are not well represented in the older veteran population. This means caution should be used in generalizing these results to female veterans. The findings may also be less generalizable to people of color, non-veterans, and veterans who do not use VA services. Since frailty was only measured once (at baseline), these results cannot account for the effects of progressive disabilities over time. Nonetheless, this study highlights the importance of assessing and addressing depression and suicidality among frail older adults. Kuffel, R. L., Morin, R. T., Covinsky,
K. E., Boscardin, W. J., Lohman, M. C., Li, Y., Byers, A. L.
(2023). Association of frailty with risk of suicide attempt
in a national cohort of US veterans aged 65 years or older.
JAMA Psychiatry, 80(4):
287-295.
doi:10.1001/jamapsychiatry.2022.5144 Talking About
Military and Veteran Suicide The National Action Alliance for Suicide Prevention convened a panel of experts from the departments of Veterans Affairs and Defense, along with people who have firsthand experience with suicide, to take a closer look at frontline efforts to prevent suicide and discuss how they’re supporting our nation’s heroes. Speaker Bio: CW4 Cliff
Bauman Chief Warrant Officer 4 Clifford W. Bauman is the survivor of an attempted suicide. After his suicide attempt, he realized he needed support. He was diagnosed with post-traumatic stress disorder, received treatment, and now believes that counseling has made him a stronger man — and a stronger soldier. He wants fellow soldiers to know that asking for help will not end their career in the military. Clifford’s 28-year career includes working at the U.S. Army Accessions Command, Training and Doctrine Command Headquarters, and Deputy Commanding General Initial Military Training. He later deployed during Operation Iraqi Freedom. His military awards include the Soldier’s Medal, Meritorious Service Medal, and Army Commendation Medal. Keita Franklin, Ph.D. Keita Franklin, Ph.D. is the director of the Defense Suicide Prevention Office, and is responsible for policy and oversight of the U.S. Department of Defense’s suicide prevention programs. Keita previously served as the head of the Behavioral Health Branch from 2009 until 2015 and had been charged with leading the integration of U.S. Marine Corps behavioral health programs. She also directed the policy, future planning, training, technical assistance, resource management, and advocacy efforts for 17 installations and over 200,000 Marines and families across the Corps. Col. William Sean Lee, D.Min. Chaplain (Col.) William Sean Lee is the Joint Force Headquarters chaplain for the Maryland National Guard. William serves MG Linda Singh, the Maryland Military Department adjutant general, and is responsible for providing religious support to nearly 6,700 Maryland National Guard members and their families. In addition to his current assignment, William has served the Maryland National Guard as chaplain for the 115th Military Police Battalion, 136th Combat Support Hospital, 29th Infantry Division (Light) Division Support Command, and State Area Command Headquarters. Lillie Mells, L.C.S.W., BCD Lillie Mells is an Air Force veteran who was deployed in the military as a mental health provider. During her 15 years in the Air Force, she conducted individual and group military counseling sessions, and held clinics on issues such as domestic violence and drug and alcohol use. When Lillie left the service, she realized she still had a desire to serve; she now works in Virginia as a suicide prevention coordinator for the U.S. Department of Veterans Affairs. Caitlin Thompson, Ph.D. Caitlin Thompson, Ph.D., is the U.S. Department of Veterans Affairs’ deputy director for suicide prevention. Prior to this role, she spent five years as the clinical care coordinator for the Veterans Crisis Line hotline and chat service. A licensed clinical psychologist, she is assistant professor in the University of Rochester Department of Psychiatry, where she completed a post-doctoral fellowship in suicide research. In 2012, she spent five months as the VA liaison for DoD’s Defense Suicide Prevention Office. Capt. Aaron Werbel, Ph.D. Capt. Aaron D. Werbel is director of the Midshipmen Development Center at the U.S. Naval Academy, were he oversees a professional staff providing counseling, education, and prevention services to midshipmen. Aaron is a member of the American Association of Suicidology, the International Association for Suicide Prevention, and the Association for University and College Counseling Center Directors. He was appointed by the secretary of defense as a member of the 2007 U.S. Department of Defense (DoD) Task Force on Mental Health and the 2010 DoD Task Force on the Prevention of Suicide by Members of the Armed Forces. Jack Benson [Moderator] Jack Benson, a partner at Reingold,
Inc., has more than 25 years of experience leading and
advising companies, associations, and federal agencies on
growth strategy, marketing and communications, and
operational issues. He currently oversees several national
mental health and suicide prevention campaigns, including
the U.S. Department of Veterans Affairs Make the Connection
and Veterans Crisis Line initiatives. He serves as chairman
of the board for the Military Family Advisory Network and
trustee of the Washington Waldorf School. He is a member of
the executive committee of the National Action Alliance for
Suicide Prevention and is co-lead of its public awareness
and education task force. More U.S.
Veterans Have Committed Suicide In The Last Decade Than Died
In The Vietnam War - November 14, 2019 When soldiers return home from war, many may feel that the worst is over: they made it back alive, and are now free to live lives free of the mortal risks of combat. The reality, however, is much more complicated and alarming: more U.S. veterans have committed suicide between 2008 and 2017 than died during the entire Vietnam War. According to the defense news site Military.com, these alarming rates were shared earlier this fall in a report by the U.S. Department of Veterans Affairs (VA). The U.S. suffered around 58,000 fatalities over the course of the Vietnam War — which lasted from 1955 to 1975 — and these deaths made it one of the most culturally affecting wars of the post-WWII era. That conflict has now taken a back-seat to the ongoing crisis of U.S. veteran suicides, which has now claimed the lives of more than 60,000 U.S. veterans. This utterly confounding statistic serves as a stark reminder that a focus on mental health for those returning from combat may be far more critical than treatment from physical injuries. While the total number of veterans declined by 18 percent over the decade after 2008, the fact remains that more than 6,000 veterans committed suicide each and every year during that same timeframe. The VA’s 2019 National Veteran Suicide Prevention Annual Report also revealed that in more than half of veteran suicides, a firearm (was used.). Guns were the suicide method for 70.7 percent of male veterans in 2017, compared to 43.2 percent of female veterans that same year. While the VA’s report didn’t account for how beneficial or effective its various mental health and outreach programs have been during the 10-year period there is clearly a critical need that is not being met as the rate of veteran suicide continues to increase with each and every passing year. According to Stars and Stripes, 6,139 veterans killed themselves in 2017, an increase of two percent over veteran suicides the previous year — and a total increase of six percent since 2008 The report also found that there’s an unnerving number of suicides among former National Guard and Reserve members. These veterans were never activated, as the military describes it, and thus have no access to VA services. Within this group, there were 919 suicides in 2017, a rate of 2.5 suicides per day. In total, around 12.4 percent of all
military suicides in 2017 came from this group. It was also
the first year that the suicide rate for veterans reached
1.5 times the rates for non-veteran adults. VA
says veteran suicide rate is 17 per day after change in
calculation September 20, 2019 The VA released its annual National Veteran Suicide Prevention Report on Friday, tracking the changes from year to year. The 2019 report includes data from 2017, the most recent available. More veterans died by suicide in 2017 than the previous year, the report shows. There were 6,139 veteran suicide deaths in 2017, an increase of 129 from 2016. However, the new report lists the daily average of veteran suicides at 17, down from the 20 per day reported in previous years. The VA explained that it removed servicemembers, as well as former National Guard and Reserve members who were never federally activated, from its count. There were an average of 2.5 suicide deaths per day in 2017 among National Guard and Reserve members who were never federally activated, the report shows. The report doesn’t include active-duty servicemember suicides. The VA said in a statement the Department of Defense would publish a separate report focusing on those deaths. “This change was necessary because these groups are unique and do not all qualify for the same benefits and services, therefore they require individualized outreach strategies,” the VA said in a statement. It was revealed last year that the 20-per-day statistic was misunderstood and included the deaths of active-duty servicemembers and members of the Guard and Reserve, not just veterans. At the time, Craig Bryan, a psychologist and leader of the National Center for Veterans Studies, said the distinction could help advocates in the fight against military and veteran suicide. “The benefit of separating out subgroups is that it can help us identify higher risk subgroups of the whole, which may be able to help us determine where and how to best focus resources,” Bryan said. The new report shows that suicide among veterans continues to be higher than the rest of the population. The suicide rate among male veterans was 1.3 times the rate for other adult men in 2017. For women, the contrast is even more stark. The rate among female veterans was 2.2 times the rate for other adult women that year. Veterans continue to use guns more than any other means of suicide. Firearms were used in nearly 70 percent of veteran suicides in 2017. For the rest of the U.S. population, firearms were used in 48 percent of suicides. The highest suicide rate was among younger veterans, ages 18 to 34. In 2017, there were 44.5 suicides for every 100,000 veterans in that age group. While younger veterans account for the highest rate of suicide, older veterans had the greatest total number of suicides in 2017. Veterans ages 55 to 74 accounted for 38 percent of all veteran suicide deaths that year. VA Secretary Robert Wilkie said the data was “an integral part of our public health approach to suicide prevention.” A federal investigation found last year that the money and effort expended by the VA on suicide prevention outreach dropped significantly in 2017 and 2018, despite it being touted by the past two VA secretaries as their top clinical priority. The Government Accountability Office reported in December that the VA left nearly $5 million unused in its suicide prevention outreach budget. The number of social media posts, public service announcements, billboards, and radio, bus, Facebook and print advertisements declined in 2017 and 2018. The agency claimed there has since been significant improvements. In June, Keita Franklin, the director
of the VA’s suicide prevention office, left the agency
after holding the position for nearly two years. Veterans
Crisis Line Director Matt Miller took the job on an interim
basis. A permanent replacement has yet to be named. Do more than 20
veterans die by suicide every day? April 24th, 2019 at
3:55 p.m. Saying that the goal of the bill is to "connect more veterans with the mental health care they need and earned," Manchin said in the release that "it is estimated that more than 20 veterans die by suicide every day" and that "of those, 14 have received no treatment or care from the VA." The data needs to be put into context, but the statistic is largely on target. The VA’s data In 2016, the Department of Veterans Affairs’ Office for Suicide Prevention published a report that found that "in 2014, an average of 20 veterans died by suicide each day. Six of the 20 were recent users of Veterans Health Administration (VHA) services in 2013 or 2014." The report said that the data "confirms that when compared to their non-veteran peers, most veterans are at an increased risk for suicide." At the same time, the report cautioned that the overall number of daily suicides obscures key variations within age group and sex within the veteran population. For instance, veterans between 18 and 39, between 50 and 69, and 80 and older have seen increases in suicide rates, the report found. And suicide rates are higher for male veterans than female veterans. The report found that suicide is likeliest among younger veterans of both sexes and among older male veterans. But since these groups account for a relatively small share of the total veteran population, the largest number of suicides occur among the much larger population of middle-aged veterans. A 2018 update by the VA found that the average number of veteran suicides per day had remained "unchanged at 20." We checked with Robert Bossarte, the director of Injury Control Research at West Virginia University who helped author the VA’s 2016 report. He told PolitiFact West Virginia that he considers the 20-a-day figure to be accurate. Our Ruling Manchin said, "It is estimated that more than 20 veterans die by suicide every day." The most recent Department of Veterans Affairs data confirms that figure, though it’s worth adding some context -- that the overall figure obscures significant variability for different age groups and for men as opposed to women. We rate this statement Mostly
True. VA
reveals its veteran suicide statistic included active-duty
troops June 20, 2018 For years, the Department of Veterans Affairs reported an average of 20 veterans died by suicide every day – an often-cited statistic that raised alarm nationwide about the rate of veteran suicide. However, the statistic has long been misunderstood, according to a report released this week. The VA has now revealed the average daily number of veteran suicides has always included deaths of active-duty servicemembers and members of the National Guard and Reserve, not just veterans. Craig Bryan, a psychologist and leader of the National Center for Veterans Studies, said the new information could now help advocates in the fight against military and veteran suicide. “The key message is that suicides are elevated among those who have ever served,” Bryan said. “The benefit of separating out subgroups is that it can help us identify higher risk subgroups of the whole, which may be able to help us determine where and how to best focus resources.” The VA released its newest National Suicide Data Report on Monday, which includes data from 2005 through 2015. Much in the report remained unchanged from two years ago, when the VA reported suicide statistics through 2014. Veteran suicide rates are still higher than the rest of the population, particularly among women. In both reports, the VA said an average of 20 veterans succumbed to suicide every day. In its newest version, the VA was more specific. The report shows the total is 20.6 suicides every day. Of those, 16.8 were veterans and 3.8 were active-duty servicemembers, guardsmen and reservists, the report states. That amounts to 6,132 veterans and 1,387 servicemembers who died by suicide in one year. The VA's 2012 report stated 22 veterans sucumbbed to suicide every day – a number that’s still often cited incorrectly. That number also included active-duty troops, Guard and Reserve, VA Press Secretary Curt Cashour said Wednesday. VA officials determine the statistic by analyzing state death certificates and calculating the percentage of veterans out of all suicides. The death certificates include a field designating whether the deceased ever served in the U.S. military. Information in the 2012 report wasn’t as complete as the newer ones. At the time, only 21 states shared information from their death certificates. California and Texas, which have large veteran populations, were two of the states that didn’t provide their data. “Since that report was released, we have been closely collaborating with the [Department of Defense] to increase our level of accuracy in reporting,” Cashour wrote in an email. Following the release of the new National Suicide Data Report on Monday, some veteran advocates responded on social media with questions. One person said the community was “thrown off.” Bryan said the situation “highlights a common source of confusion regarding who is and who is not considered a ‘veteran.’” Heidi Kar, a project director at the nonprofit Education Development Center and a clinical psychologist with expertise in veteran suicide, said she had previously understood the statistic to be a veteran-only number. Overall, Kar thinks the VA put more emphasis in its latest report about suicide as a public health issue that requires the help of multiple agencies and community-based groups. The report shows that of the 20.6 veterans and servicemembers who died by suicide every day, six had recently used VA health care services. The suicide rate among the people who didn’t receive VA care increased faster than ones who did. “The biggest message is that suicide prevention is everyone’s job,” Kar said. “It’s a problem for active duty, it’s a problem for vets, it’s a problem for the elderly and for young people. So, the response has to be multidimensional, and different sectors have to problem-solve together.” The VA said in a statement that it’s working with the Defense Department and the national Centers for Disease Control and Prevention to publish 2016 suicide statistics in the fall. The agency said it’s part of an ongoing review of millions of death records that could lead to improvements in the VA’s suicide prevention programs. To contact the Veterans Crisis Line,
veterans, servicemembers or their families can call
1-800-273-8255 and press 1. They can also text 838255 or
visitveteranscrisisline.net
for assistance. Veteran suicide
rates remain alarmingly high despite years of
reform For U.S. Army veteran Tom Voss, it was the unseen wounds of war that gushed from his body and crippled his insides day in and day out. Suicide rate increased 40 percent in US from 2000-2023, mining, construction workers at highest risk: CDC report https://www.foxnews.com/health/suicide-rate-increased-40-in-u-s-since-2000-cdc-report While more than 6,000 miles from the battlefields of Iraq and back in the beloved land he served, Voss no longer felt at home in his skin. The wincing memories of doing or witnessing horrific things that collided with his fundamental beliefs – the “moral injury” – walked like a shadow alongside him and inside him, propelling him toward suicide as a means to end the pain and suffering. “You are trained in the infantry to move through challenges without asking for help. When I got out of the military, that is what I tried to do,” Tom Voss, co-author of “Where War Ends: A Combat Veteran’s 2,700-Mile Journey to Heal,” told Fox News. “But that caught up with me down the road.” The issue of veteran suicides has long plagued the nation and been a bipartisan cause for concern among the political establishment. But why is it that the numbers remain so alarmingly high? “You have to approach this very much like one of the really top health issues, like cancer,” said Dr. David Shulkin, former Secretary for Veterans Affairs (VA) and author of the new book “It Shouldn’t Be This Hard to Serve Your Country.” “This is going to be a long-term journey and try to address the issues surrounding brain health.” According to the 2019 National Veteran Suicide Prevention Annual Report, 45,390 American adults died from suicide in 2017 – the most recent available year of data collection – including 6,139 U.S. veterans. The report stated that the number of veteran suicides has exceeded 6,000 every single year between 2008 and 2017, and in 2017, the suicide rate for veterans was 1.5 times the rate for non-veteran adults. In 2005, an average of 86.6 American adults, including veterans, died by suicide daily. In comparison, an average of 124.4 Americans died by suicide daily in 2017, indicating a sharp rise across the country. Specific to veterans, the study found that suicides increased from 5,787 to 6,139 over those 12 years. In 2005, an average of 15.9 veterans died by suicide daily, and in 2017, an average of 16.8 veterans died by suicide each day. The report also underscored that for each year, from 2005 to 2017, veterans with recent Veterans Health Administration (VHA) use had higher suicide rates than other veterans. Of those VHA users, 58.7 percent had a diagnosed mental health or substance use disorder. Suicide rates were also highest among those diagnosed with opioid abuse disorder or bipolar. In terms of age groups, veterans between 18 and 34 were deemed to have the highest suicide rate in 2017, at 44.5 per 100,000. This marked an uptick by 76 percent from 2005 to 2017. Nonetheless, the “absolute number” of suicides was highest among the veterans in the 55-74 age category, amassing 38 percent of total suicide deaths. Analysts surmise this is because there are simply more veterans accumulating as time goes on, and also because the older one gets, generally the more isolated and lonely they become. The veteran suicide rate for women veterans was concluded to be 2.2 times higher than non-veteran women. However, the suicide numbers were 1.3 more for male veterans than non-male veterans. Moreover, there were 919 suicides among “never federally activated former National Guard and Reserve members in 2017,” averaging 2.5 suicides a day. So what is the path forward to addressing the stagnant crisis? “We know that the suicide rate is climbing across the United States for all Americans and in all states. But veterans are also unique: the suicide rate in the military doubled in the first decade of 2000 and had remained elevated ever since,” said Rajeev Ramchand, a behavioral scientist and fellow at the veteran support-focused Bob Woodruff Foundation. “And the youngest group of veterans, those 18-34, have the highest suicide rate. This suggests to me that there is also something specific about the recent military experience that is contributing to suicide risk.” In Voss’ case, he sought to confront his demons by embarking on a 2,700-mile expedition across the U.S., grasping for solace along the way. “We have to look at the whole life cycle of a military person, how we are teaching them to manage stress when they come in (to the military) as there are a lot of people already coming in with trauma. Giving them the tools to manage stress only strengthens our military in deployment and when they come home,” he said. “Things like meditation, yoga – these things were created thousands of years ago to manage the mind.” Shulkin concurred that veteran suicide needs to be fought in a “multifaceted way,” incorporating integrative processes like yoga and tai chi, emotional support dogs, equine therapies, and cannabis for specific situations. Firearms were also singled out by researchers for having been used in 70.7 percent of male veteran suicide deaths, and some 43.2 percent of female veteran suicides in 2017 – averaging out at 69.4 percent – as the means of self-inflicted injury. By comparison, firearms were used 48.1 percent of non-veteran suicides in 2017. “The biggest oversight is the clear relationship between firearm availability and suicide. Locking up one’s firearms using safes or other locking devices has been shown to reduce suicides by almost half,” Craig Bryan, who studies the issue at the National Center for Veterans Studies at the University of Utah, said. “Probably the best evidence to support this comes from the Israeli military. When they changed their policies requiring soldiers to store their military firearms in the armory on weekends, they observed a 70 percent reduction in firearm suicides and a 40 percent reduction in the overall military suicide rate.” In his words, it’s a simple change — “storing guns safely led to an enormous drop in suicides.” In 2015, both chambers of Congress unanimously passed the Clay Hunt Suicide Prevention for American Veterans Act, named in honor of a former Marine sniper who took his own life in 2011 after failing to receive the needed VA health care. The bill was designed to improve mental health and suicide prevention services at the Department of Veterans Affairs. In 2018, the Government Accountability Office (GAO) pinpointed bureaucratic confusion and unfilled work positions as key contributors hampering VA anti-suicide efforts, described as a “deeply troubling level of incompetence” by Rep. Tim Walz (D-Minn.) who requested the investigation. The VA announced it would immediately address the red flags. Yet it has been argued that, despite years of congressional funding and an uptick of studies, it has been challenging to zero-in on the specified causes that lead to suicide or suicide attempts. Bryan hopes that the murkiness is now starting to shift in favor of a clearer picture. “On the health care side, we need to increase access to the most effective treatments,” Bryan noted. “Unfortunately, we tend to focus on access to care without focusing on the quality of care.” Thus as suicides continued to rise, last year, the Trump administration opted for a more aggressive approach. In May 2019, President Trump signed an executive order called the PREVENTS Initiative, aimed at arming state and local governments with the tools and resources needed to identify and intercede when a U.S. veteran is considered to be at risk of suicide. PREVENTS also seeks to raise public awareness of veteran’s struggles and allocate more money specific to mental health programs. A presidential task force, which has subsequently been formed to illuminate ways to make data collection faster and coordinate federal and state resources, has also vowed to increase VA outreach and further education on firearms and its relationship to veteran suicide. Given that the data lags two years behind, it remains to be seen whether Trump’s initiative bears fruit in combating the epidemic. Nonetheless, the VA states that suicide prevention remains a primary focus. So what else is being done? A spokesperson for the VA insisted that "suicide prevention is VA’s highest clinical priority, and the department is taking significant steps to address the issue. The Joint Commission explained that “The US Department of Veterans Affairs (VA) has been able to reduce the number of in-hospital suicides from 4.2 per 100,000 admissions to 0.74 per 100,000 admissions on mental health units, an 82.4% reduction, suggesting that well-designed quality improvement initiatives can lead to a reduction in the occurrence of these tragic events.” A representative also emphasized that "all VA health care facilities now provide same-day services in primary and mental health for Veterans who need them." Since 2017, the department has been actively coordinating across its networks, as well as working in close partnership with the White House, Congress, the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, and local communities. A Veterans Crisis Line expanded its text and chat access, and claims to have improved from answering 70 percent of incoming calls in 2017 to 99.6 percent of calls without rollover in 2019. The VA also attests to making progress in “clinical research developing and testing evidence-based psychotherapy advances, medications and alternative approaches to treating PTSD,” in addition to significantly broadening community partnerships, clinical partnerships, and outreach. Other initiatives in the VA pipeline include the Puppies Assisting Wounded Servicemembers (PAWS) Act, which would require that the VA offer $25,000 vouchers to veterans diagnosed as having PTSD. As it stands, the VA only financially backs service dogs for use related to mobility and physical needs, rather than mental needs. The bill was introduced last summer by Rep. John Rutherford, R-Fla., but is yet to reach the House floor. Last year, the VA also kicked off an outreach suicide prevention program in rural regions, having determined that suicide rates were heightened among those in more isolated pockets of the country. Dr. David Shulkin, former Secretary for Veterans Affairs (VA) and author of the new book “It Shouldn’t Be This Hard to Serve Your Country.” Dr. David Shulkin, former Secretary for Veterans Affairs (VA) and author of the new book “It Shouldn’t Be This Hard to Serve Your Country.” According to Shulkin, the key lies in a hybrid partnership between the public and private sectors, and in making better use of the money available. “When you look back at the problems of the VA, many have been systematic and span decades. It’s a system that needs to be updated and modernized. It needs to do things like embrace technology and give nurses more practical authority,” he underscored. “It’s not about just throwing more money at it. I have never felt that the VA suffered from a lack of financial support, but it needs to be internally evaluated in creating a better system of care.” Voss, who co-authored “Where War Ends” with his sister Rebecca, also highlighted the importance of giving families a “peek behind the curtain” in the hopes that loved ones can ascertain a richer understanding of the moral traumas suffered by veterans. “For our family, the writing was
healing — talking about the sorrow and shame and
survivor’s guilt,” Rebecca added. “We need to
all understand what war does to people. If we don’t
understand, we aren’t understanding the real costs of
sending our children into battle.” Be There:
Help Save a Life VA has built the Nation’s
largest, most comprehensive mental health care and suicide
prevention program to end Veteran suicide. This integrated
effort connects Veterans and their families with services
and support across VA through VA Medical Centers, Vet
Centers, outpatient clinics, and Suicide Prevention
Coordinators. Learn more about the resources available to
Veterans and Service members in crisis, and their friends
and families, at VeteransCrisisLine.net A vets reply: Ask that question on FB, twitter, or any social page that has some or all veterans, & they are sure to find someone who has a been there done that, who actually was there, & understands xactly what that person is going through, ... And I'm putting this out there so I
can maybe be there, if, when, they might need to talk to
someone, willing to listen, ... Cause I've been down that
road myself, & still struggle to to stay upright,
fighting the good fight, on the inside, but now, I know I am
not alone, that there is support, & there is reachable
assistance, even if it was only to open a door. Gun Storage
Practices among U.S. Veterans A national study found that one in three U.S. veteran gun owners stores at least one gun loaded and unlocked in their home. Gun storage practices differ based on individual and household sociodemographic factors, gun ownership characteristics, and risk perceptions. This research offers insight into gun storage practices that can help inform suicide prevention efforts among veteran gun owners. Data from this study came from the National Firearms Survey, an online survey designed to assess gun ownership and storage practices among a nationally representative sample of adults. For this study, researchers used data from 561 veterans who owned guns. They found 33.3 percent of veteran gun owners stored at least one of their guns loaded and unlocked. Sixty-six percent of veteran gun owners stored at least one gun unlocked, and 46.7 percent stored at least one loaded. Study participants were more likely to report storing a gun loaded and unlocked if they were male, did not have children in their household, and owned a greater number of guns. The likelihood of storing at least one firearm loaded and unlocked was higher among those who reported personal protection as the primary reason for gun ownership, and among those who agreed that having a gun in the home makes the household safer. Simonetti, J. A., Azrael, D.,
Rowhani-Rahbar, A., & Miller, M. (2018). Firearm storage
practices among American veterans. American Journal of
Preventive Medicine, 55(4), 445–454. Where does
the battlefield end? Where can veterans and service members
turn for mental health support? How do military family
members find help? To further this discussion, the NNDC has
partnered with the consumer advocacy group Care
For Your Mind Beyond The
Battlefield: Lack Of Long-Term Care Can Lead To Tragic Ends
For Wounded Veterans Jimmy Cleveland Kinsey II was a good Marine who got blown up in Iraq and struggled for years with his wounds and with the demons that came with them. Eventually he lost, dying sick and alone, facedown on the floor of a Houston hotel room. He was 25 years old. His young wife, Karie, had stayed with him in the years leading up to his death, in countless hospital wards and hotel rooms, changing his dressings, soothing his pain, managing his medicines, absorbing his moods, struggling to keep his well-being ahead of her own. The wounded warriors visible to most Americans are the survivors, those who overcome debilitating injuries through their own perseverance and the hard work of military medical teams, friends and family. There are those who rise even further above adversity, competing in the Paralympics, giving motivational speeches, enjoying standing ovations and special guest appearances at ballgames and State of the Union addresses. Others come home wounded, and don't make it much further. For them, the quality and type of medical care they require simply isn’t available on a long-term basis, and that’s a problem the military and the Veterans Administration have yet to fully wrestle to the ground. Kinsey was among those who are burdened with chronic pain and depression, with drug addiction, with the anguish of losing buddies in battle. Along with their physical injuries, they seem wounded with the shock and loss of finding themselves flung abruptly from the high-adrenaline camaraderie of battle into a harsh, solitary world of hospitals and rehab -- disoriented in a civilian world where nobody understands war or is paying much attention, and where they struggle to come to terms with their future as young, disabled Americans. Jimmy Cleveland Kinsey II -- "Cleve,'' to tell him apart from his dad -- was a south Alabama boy, six feet and three inches of energy and mirth, with a weakness for radio-controlled model planes and, later, a 1988 Mustang Saleen. He also had an eye for a pretty local girl named Karie Fugett, whom he met in the eighth grade and, years later, met again when he was a Marine riding US Airways into Jacksonville, N.C., on his way to Camp Lejeune, and she was a flight attendant. Jimmy and Karie became inseparable, joking and laughing and partying, and it wasn't long before they eloped. Ninety-nine days later, Jimmy, deployed on his second combat tour in Iraq, drove over a land mine in Ramadi, Iraq. He was trapped in the overturned burning vehicle; the blast left him with shrapnel wounds, burns, a mangled leg, post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). That was in April 2006. He was 21 years old. Karie, who rushed to his side at Bethesda Naval Hospital, was 20. "The next four years were spent in hospitals and hotel rooms,'' Karie wrote in her blog. "I was scared, I was exhausted, and I felt very alone. "We were fighting to get his life back, and fighting to make a marriage work through pill addiction, overdose, miscarriage, family feuds, infections, amputation, PTSD and TBI. "There were amazing times that made everything worth it, and there were times I truly felt like I was in hell.'' 'THE GOOFIEST AND FUNNIEST PERSON EVER' Jimmy had been bedridden for three months after he was blown up, and then was able to hobble around on crutches. Surgeons were trying to save his leg, which the blast had shattered. Most of his calf muscle was gone and doctors were trying to replace it with muscle transplants from his back. He was also going to an outpatient clinic to deal with the brain injury he had suffered in the blast. He hurt all over. He had nightmares and anxiety attacks. He was on methadone and Percocet, a narcotic pain reliever, and over the months was taking morphine and Dilaudid, addictive pain relievers. Occasionally, according to Karie, he was prescribed Seroquel and Klonopin for anxiety and panic disorders. The pills helped. More pills helped even more. "He used the pills to escape,'' Karie recalled. "The thing is, he took more than he was supposed to … and that, mixed with his brain injury, was scary,'' fueling fits of anger and violence. "I felt he was abusing his pills and I didn't want that.'' She begged doctors to find alternative treatments but she said she was told the pills were necessary. She was at her wits' end. "The thing that got me was the amount of times I told the military to please, please help me come up with a way to help him with his addiction and wean him off of the pills. I thought he needed inpatient drug addiction therapy. He needed help and I didn't feel like anyone would listen to me.'' So she flushed the pills down the toilet. She and Jimmy got into an argument over the pills and he flew into a rage. Karie stood her ground. He headbutted her and tried to choke her. "I knew he had his anger problems just like I did,'' said Justine Brown, one of Jimmy's closest Marine buddies, who also had been wounded. "They tend to throw you on a lot of medications, and you know you need to get off them but you just can't. It makes you sad and angry.'' For his part, Jimmy told Karie the pills made him crazy, that he "didn't feel right,'' but couldn't stop. "He was the goofiest and funniest person ever,'' Karie told me. "Those are the times you live for, and they love you so much, and then he'd hit me and go into a rage and then when he realized what he did he'd fall to the floor and bawl. You'd just want to hold him.'' For years, Karie stuck with it. "I convinced myself that I was okay with him hurting me. As long as at the end of the day I know I was there for him, I didn't even care if I died.'' Eventually, the bone in Jimmy's left leg became infected, and doctors at Bethesda concluded they couldn't save it. He called Karie, who was at work in North Carolina, and said they were going to take it off. She drove all night and got there in the morning to find him with a bandaged stump. It seemed to throw them both deeper into depression. "He fought so hard to keep that leg,'' Jimmy's mother, Penny, recalled, through tears. "It was a year and a half of surgeries, antibiotics … I was devastated.'' A RESPITE For a brief time, things got better. Doctors moved Jimmy from Bethesda to the former Walter Reed Army hospital several miles away for a prosthetic leg and physical therapy. He began to walk haltingly, and joined outings and trips for the wounded and their families; he and Karie went to New York City and stayed at a hotel in Times Square, watching the celebrations on Election Night 2008. Karie discovered a group of other despairing spouses of wounded soldiers and Marines and found support in online chat rooms. She got away with them once for a gala weekend in Las Vegas organized by a nonprofit, Wounded Warrior Wives. But the loss of Jimmy's leg, and the ravages of his brain injury and post-traumatic stress disorder, were weighing them both down. Eventually, Jimmy's pain and depression brought deepening addiction. One night in late 2008, Karie awoke with a start to find Jimmy bucking and grunting in bed, purple-faced and covered with vomit. He was overdosing. She heaved him off onto the floor, called 911, cleared his mouth and throat and gave him CPR. When the EMTs arrived, they found Jimmy almost dead and shot him with adrenalin before taking him to the hospital. Karie stayed with him there the rest of the night. When Jimmy awoke in the morning he was furious at her for calling 911, and yelled at her to get out. She left, found a corner where she could be alone, and sobbed with exhaustion and anger and frustration and loss. Days later he apologized; he hadn't understood that she had saved his life. A week after the overdose, Karie found out she was five weeks pregnant. She was overjoyed. A few days later, she miscarried. "At this point, I'm afraid to even talk to God,'' she wrote in her blog. "Maybe He's mad at me. Maybe I've asked for too many favors and He's tapped out.'' Jimmy was granted medical retirement from the Marine Corps. He received a 90 percent disability rating, which meant $1,100 a month less than they were expecting. And there was a months-long gap between the end of his military pay and the start of his veteran's disability payments. Karie got a job as an online matchmaker, earning $10 an hour. The police arrested Jimmy one night for unpaid parking tickets and nobody could afford his bail. He would disappear for days at a time, then return and threaten Karie at gunpoint. "Basically I was scared for my life,'' Karie recalled. She was having her own breakdown: nightmares, fits of anger, panic attacks so bad she'd rip off her shirt so she could breathe. For her own sanity, she began to see her girlfriends from high school. Jimmy was furious when he’d come home and find her gone. One night he threw her clothes out into the yard and smashed beer bottles on top of them, and yelled at her that he'd kill her if she ever came back. She fled. Karie said she finally realized that Jimmy was going to have to climb up out of his addiction and depression by himself. She sent him a list of things he'd have to do to win her back. That seemed to work. He enrolled in PTSD therapy. He began to pay his own bills. "He was making changes,'' she said. "They were slow, but I could see it happening. For the first time he was doing things on his own because he finally wanted to.'' But it was hard, she said, bearing "the pain of leaving the person I cared about more than anything in the world.'' A few months later, while Jimmy was a patient at Project Victory, a private, nonprofit facility for veterans in Houston, the bottom fell out. NEUROSPSYCHIATRIC CASUALTIES No one seems to know how many people there are like Jimmy and Karie, whose young lives and dreams are abruptly shattered by a random explosion, and whose trajectories seem to spiral down through layers of misery and depression and disintegration. But there are enough of them to have prompted growing concern among some senior officials in the Defense Department and the VA that caring for the physical, visible wounds of the combat-injured is not enough. "If you have a severe injury, you can get to a high level [of activity] with intensive care, but it's really hard to keep doing that,'' said Dr. Shane Mcnamee, chief of physical medicine and rehabilitation at the Veterans Administration Polytrauma Hospital in Richmond, Va. "It's hard every day to struggle with the pain and stress, the forgetfulness. If we're not there to support them, they will get worse,'' he said. "You need strong, loving, caring advocates who can care for these individuals and continue to push them, and a health care team that can be responsive not just to the day-to-day pieces, but can pick their head up above the horizon and set goals that are significant and reachable.'' That theme -- that the military and veterans health care systems fail to provide "strong, loving, caring'' support -- was hammered home in a hearing this summer of the Senate Veterans Affairs Committee, whose chair, Patty Murray (D-Wash.), noted the awful toll of veterans who slip through the cracks. Suicide is only one indication of their despair, but it's a powerful one. Among the troops who have returned from war with severe mental health issues, including those from the Vietnam era, "an average of 18 veterans kill themselves every day,'' Murray noted. A senior Veterans Affairs official acknowledged poor coordination among various bureaucracies of the VA and other federal and private agencies. "For those veterans with a complex interplay of mental health, medical and psychosocial issues, VHA [Veterans Health Administration] needs to better coordinate care internally among providers and clinics, between VBA [Veterans Benefits Administration] and VHA and when possible between private sector health care providers, families and VA,'' Dr. John D. Daigh, of the Veterans Affairs Inspector General's Office, told the Senate hearing on July 14. "The military is faced with a problem: we have salvaged people, we can give them the physical tools back, and they begin to fall into another category of injury, the neuropsychiatric casualty,'' said Dr. Dale Smith, a medical historian at the Uniformed Services University of the Health Sciences in Bethesda, Md. "Some of it is the stigma of a prosthesis. The other piece is a psychological component of having been wounded, having had their bell rung. They aren't as quick to jump back to the fight -- the resilience is just not there." "We have to get a better handle on understanding this problem,''' he added. Military medical authorities have been aware of the links between PTSD, narcotics, risk-taking behavior and suicide for years. A U.S. Army study on pain management, chartered in August 2009, said the Army is "deeply concerned'' about drug addiction and suicide. But it faulted military medicine for failing to have any "routine or standardized screening for those at risk.'' Nor, it added, "is there a system to share'' information on what medications the combat injured are being given and how that might affect their treatment. Seeming to describe the peril into which Jimmy Kinsey had fallen, the Army's Task Force on Pain Management reported that the "highest risk patients for unsafe behaviors have a 'trio diagnosis' of psychiatric disease, substance abuse, and pain." "These patients are complex and need multidisciplinary evaluations … patients receiving higher doses of prescribed opioids are at increased risk for overdose, which underscores the need for close supervision of these patients,'' the report warned. "Often patients, especially with a history of impulsivity or medication misuse, will choose to use lethal medication as a means of suicide.'' That clarion call, for close professional supervision of these "complex'' patients who are at an increased risk of overdose, appears to have gone unheeded during Jimmy’s struggle. Once during that hard period, Karie wrote in her blog: "Cleve has been taking the morphine the VA gave … I've been holding onto it and giving it to him when it's due. It still pisses me off so bad that I am being put in this position. It is bull-youknowwhat. Luckily, so far, it hasn't been so bad other than the lack of sleep from waking up and checking his pulse sporadically. I can feel the "I NEED MORE BECAUSE I'M STILL IN PAIN" argument lurking, though. He mentioned it yesterday, but I don't care. I'm giving him what is on the bottle. If it doesn't work, he needs to take it up with his doctor. I just hope I get more sleep. I had a nightmare last night, too, that was pretty gnarly ... When I woke up from it Cleve wasn't snoring. I put my hand on his chest to.... well... make sure he was still alive. He was actually awake. I told him I had a nightmare. He turned my way and put his arm around me, then everything was OK. "If the VA doesn't solve this pill issue I'm ready to raise hell. Pills are not OK for this family! End of story. Find something else!'' A few days later: "VA appointment today. I hope we get his meds fixed and maybe his other injury [prescriptions] filled, or started at least.'' The next day: "The VA appointment was crap. All they did was give him more morphine. Ugh. I guess this is a battle I'm going to lose. They set up an appointment with the actual pain management clinic. Today was just some random doctor. I really don't think they can do anything. Such crap. I just felt defeated. Couldn't even fight her on it. The doctors hands are tied anyway.'' By the fall of 2009, the Kinsey’s marriage had reached a tipping point. Karie had come to the painful decision that Jimmy would have to take charge of his life himself; she'd done all she could. She had moved out and was struggling to make ends meet. She was on the phone with Jimmy almost once a day, and things were up and down. She was hounded by doubts about what she was doing, trying to force him to take control of his own life. "I failed to make this work. I can honestly say I have never tried so hard at something in my life. I wish this wasn't happening,'' she wrote. "I'm terrified. I'm depending on others. I hate this. I wonder how many other caregivers end up on the street because they are scared of their husband or have been kicked out. I feel really alone. My mind is not working correctly right now. I feel destructive. I'm embarrassed … I've been a wife and caregiver for so long, I don't know where else I fit. Who am I? What do I do?'' PROJECT VICTORY Continuing to seek help, Jimmy enrolled in a private PTSD clinic in Houston called Project Victory, where treatment for traumatic brain injury was offered free to veterans of Iraq and Afghanistan. Project Victory is funded with grants and donations through the TIRR Foundation, a Houston nonprofit that, according to its website, serves patients with central nervous system damage. The TIRR Foundation set up Project Victory in 2007, according to its website. Jimmy was still on pain meds, with a Medtronic Restore Ultra neurostimulator implanted near his spinal cord, prescribed for chronic pain, and Fentanyl, a powerful painkiller, normally given to patients with severe pain. He received the drug through a skin patch, which was well known to be a risk to patients with a history of drug abuse and addiction. On the street, the word was that drying the Fentanyl contained in the patch and smoking it would give you a powerful high. In Florida alone, 115 people had died in overdoses of Fentanyl in 2003 and 2004. Despite their separation, Karie drove Jimmy to the airport for the short flight to Houston. "If I knew he would die I would have hugged him longer,'' she wrote later. "I would have … well, caged him up and not let him out of my sight. Told him I loved him one more time. Touched him one more time.'' At Project Victory, patients were housed in a Marriott Residence Inn adjacent to the Project Victory facility. Patients typically stayed eight to 10 weeks. Jimmy and other patients lived at the Marriott, and during the day, walked the short distance to Project Victory's therapy sessions. Late afternoons and evenings, they were on their own, according to Jimmy's family. Karie and Jimmy talked by phone around 4:30 p.m. on Monday, April 19, 2010, and it was a good conversation. "For the first time, he had a plan,'' Karie wrote. "He had hope. He wanted to change. He wanted to really work on fixing us. "I remember getting off the phone and thinking, I really really hope I'm not disappointed again.'' Jimmy said he would call back later that night after he ran some errands. He didn't call. Karie sent him a text message. No response. Late afternoon the next day, Karie was at work when her friend Robin called. Jimmy was dead, she said. His mom had put the news on Facebook. Houston police had received a call at 11:40 that morning. Report of a male deceased, “natural DOA” -- meaning no sign of trauma. Police found him facedown in the hotel room's kitchenette, lying next to a plastic bag containing a black tar-like substance and a piece of metal cut from a soda can with a black tarry residue on it. A pipe lay nearby. The Harris County assistant medical examiner, Marissa L. Feeney, examined Jimmy's body. She found and removed the Medtronic neurostimulator and an empty Greenfield filter, used to prevent pulmonary embolism, in his abdominal cavity. She also found his breathing passages, the trachea and bronchi, clogged with foam. Her diagnosis: Jimmy Kinsey died from acute fentanyl toxicity. "He died from an accidental overdose,'' Jimmy's mother, Penny, told me from the family home, at the end of a small dirt road in Foley, Ala. "He was dependent on his drugs, that had a lot to do with it.'' I asked her gently if she felt it really was accidental. After a long pause, she said, "I honest-to-God don't know. He was going through so much at the time. He always swore to me he would never do that. I don't know if it was intentional or … "I do feel,'' she said, "like he was forgotten.'' The last days of Jimmy Kinsey's life are shrouded in mystery, owing in part to restrictions on the release of private medical records. Jimmy's widow and family were devastated by his death and exhausted by the long struggle. They have not demanded to know the details of his final hours. In a telephone interview last spring, I talked with Shawn Brossert, the program coordinator of Project Victory, without mentioning the case of Jimmy Kinsey. Brossert told me she had moved the clinic to a new facility in Galveston, Texas. "We found we wanted a more restrictive environment'' for the patients, she said. "Some [patients] needed more oversight than we could provide'' as an outpatient clinic at the facility in Houston. The move to better facilities with more supervision came just months after Jimmy's death. I called her again in August and said I had questions about the death of Jimmy Kinsey. She declined to talk other than to say someone "more responsible'' would have to answer, and hung up. She didn’t respond to further phone calls and emails. I sent a detailed email to Cynthia Adkins, executive director of the TIRR Foundation, which founded, funds and solicits donations for Project Victory. Its website asks for checks "payable to: TIRR Foundation, Project Victory.'' I asked if she could shed any light on Jimmy Kinsey's death, and, in particular, whether it was the VA, a caregiver, or some other third party that was in charge of his care. Adkins didn’t respond to these questions via email, and when I got her on the telephone she dismissed any inquiries about Jimmy’s death. "We have nothing to do with this,'' she said. I asked who was responsible for Project Victory. "I have no idea,'' she responded. "I cannot visit with you about this.'' Then she hung up. I sent two subsequent emails to her with the detailed questions, but never received a response. It was Jimmy himself, of course, who was most directly responsible for his own death. But where was the help and support he needed? Technically, like all veterans, Jimmy was under the care of the Veterans Administration and it was under the agency’s auspices that he received his pain medication. But he was under no obligation to turn to the VA for help with his addiction. "Veterans do have a choice about where they receive their care,'' said Antonette Zeiss, a senior VA official in Washington responsible for all VA mental health programs, including substance abuse. She said the VA has an extensive and vigorous outreach effort to contact veterans and advise them of the program available to them. "But these are American citizens with full rights and they can make choices,'' she said. "We are not in the business of tracking down and forcing anyone to come in for care.'' Drug addiction due to chronic pain is difficult to treat, but the VA has a wide range of programs designed to help veterans like Jimmy Kinsey. Although she could not discuss individual cases, she said that for veterans "who need more complex, intensive care we have residential rehabilitation programs'' for pain management, substance abuse disorder and other health problems. The problem with relying on the drug-abusing veteran to seek VA treatment, she acknowledged, is that some part of that veteran, some part of the time, simply doesn't want to be treated. "That ambivalence is very much a part of substance use disorder,'' Zeiss said, "and we have a full continuum of care for that.'' Zeiss, a psychologist, seemed to understand and empathize with veterans like Jimmy Kinsey, and clearly she knows how to help them. Tragically, she and Jimmy never met. The VA doctors and pharmacologists and therapists who saw Jimmy did not get him into the VA programs that might have saved him. Instead, he spiraled on down to his death. Karie acknowledged that the initial care provided by the military and the VA is superb. But the follow-up? Not so good, she told me. "Can they reconstruct a leg? Hell yeah, they can. It's what happens after the surgeries that they don't have a good grip on.'' Karie is the first to admit that Jimmy was hardly an ideal patient -- that his irresponsible behavior made things worse. But she also feels let down by the country that he volunteered to serve in combat. "I felt the military would not listen to us,'' she wrote to me in a long, anguished email. "But all of his actions, I believe, were a result of the injuries he received at war. And now, I'm hearing more and more of accidental overdoses, suicides, homicides … what is wrong with this picture? "For a while I thought it was only us. I thought there was something wrong with us. The reality, I'm finding, is that we were the norm. I'm afraid that the way the military and the VA handle these men and women is going to result in many more deaths similar to my husband's. "Why were these fragile people not looked after more carefully?'' If Jimmy had been killed outright in that IED blast in Ramadi, he would have been flown home in a flag-draped casket with a white-gloved honor guard and buried with full military honors. The wounded are not returned home with such honors. Nor is recognition given to the severely wounded who struggle with and finally succumb to pain, addiction and despair. In Jimmy's case, the family was left to battle with the VA to get them to pay for a graveyard headstone. "I truly feel like I lost my husband to this war,'' Karie wrote late one night. "He would not have died at the age of 25 if he had not gone to Ramadi, Iraq, and been hit by an IED. If he hadn't lost his leg, he would never have had to take those strong pain medications. He never would have had PTSD and TBI. He wouldn't have been left alone in a PTSD therapy facility to die. "I hate this stupid war,'' she wrote. "Everyone we knew from the military has been negatively affected by it. "SO sick of hearing about all the tragedy. SO sick of it.'' Jimmy Kinsey didn't get the long-term care he needed, but some of the severely wounded have been more fortunate. NEXT: Meet an Army sergeant who reports benefiting tremendously from therapy built around "the permanent caregiver" -- his family. Huffington Post Impact has compiled a list of organizations that seek to help veterans like the ones featured in "Beyond The Battlefield." You can read more about those groups, and ways you can help, here. Other stories in this series can be found here. Clarification: An earlier version of
this article could have been understood to suggest that
wounded veterans are not given full military honors at their
funerals. This is not the case. It has been changed to make
clear that wounded soldiers do not receive the same
attention or tribute that their fallen comrades do upon
their return to the U.S. The
parking lot suicides: They take their lives at the doorstep
of the VA Framed photos of her younger brother, Justin Miller, a 33-year-old Marine Corps trumpet player and Iraq veteran. Blood-spattered safety glasses recovered from the snow-covered Nissan Frontier truck where his body was found. A phone filled with the last text messages from his father: "We love you. We miss you. Come home." 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, Florida. 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. VA declined to comment on individual cases, citing privacy concerns. But relatives say Turner had told them that he was infuriated that he wasn't able to get a mental-health appointment that he wanted. Veterans are 1.5 times as likely as civilians to die by suicide, after adjusting for age and gender. In 2016, the veteran suicide rate was 26.1 per 100,000, compared with 17.4 per 100,000 for non-veteran adults, according to a recent federal report. Before 2017, VA did not separately track on-campus suicides, said spokesman Curt Cashour. The Trump administration has said that preventing suicide is its top clinical priority for veterans. In January 2018, President Donald Trump signed an executive order to allow all veterans - including those otherwise ineligible for VA care - to receive mental-health services during the first year after military service, a period marked by a high risk for suicide, VA officials say. And VA points out that it stopped 233 suicide attempts between October 2017 and November 2018, when staff intervened to help veterans harming themselves on hospital grounds. Sixty-two percent of veterans, or 9 million people, depend on VA's vast hospital system, but accessing it can require navigating a frustrating bureaucracy. Veterans sometimes must prove that their injuries are connected to their service, which can require a lot of paperwork and appeals. Veterans who take their own lives on VA grounds often intend to send a message, said Eric Caine, director of the Injury Control Research Center for Suicide Prevention at the University of Rochester. "These suicides are sentinel events," Caine said. "It's very important for the VA to recognize that the place of a suicide can have great meaning. There is a real moral imperative and invitation here to take a close inspection of the quality of services at the facility level." Keita Franklin, who became VA's executive director for suicide prevention in April, said the agency now trains parking lot attendants and patrols on suicide intervention. The agency also has launched a pilot program that expands its suicide prevention efforts, including peer mentoring, to civilian workplaces and state governments. "We're shifting from a model that says, 'Let's sit in our hospitals and wait for people to come to us,' and take it to them," she said during a congressional staff briefing in January. For some veterans, the problem is not only interventions but also the care and conditions inside some VA mental-health programs. John Toombs, a 32-year-old former Army sergeant and Afghanistan veteran, hanged himself on the grounds of the Alvin C. York VA Medical Center in Murfreesboro, Tennessee, the morning before Thanksgiving 2016. He had enrolled in an inpatient treatment program for PTSD, substance abuse, depression and anxiety, said his father, David Toombs. "John went in pledging that this is where I change my life; this is where I get better," he said. But he was kicked out of the program for not following instructions, including being late to collect his medications, according to medical records. A few hours before he took his life, Toombs wrote in a Facebook post from the Murfreesboro VA that he was "feeling empty," with a distressed emoji. "I dared to dream again. Then you showed me the door faster than last night's garbage," he wrote. "To the streets, homeless, right before the holidays." Miller was recruited as a high school trumpet player into the prestigious 2nd Marine Aircraft Wing Band based in Cherry Point, North Carolina. In Iraq, he was posted at the final checkpoint before U.S. troops entered the safe zone at al-Asad Air Base. Hour after hour, day after day, his gun was aimed at each driver's head. He carefully watched the bomb-sniffing dogs for signs that they had found something nefarious. After he came home, Miller's family noticed right away that he was different: incredibly tense, easily agitated and overreacting to criticism. He eventually told his sister that he suffered from severe PTSD after being ordered to shoot dead a man who was approaching the base and was believed to have a bomb. Miller called the Veterans Crisis Line last February to report suicidal thoughts, according to the VA inspector general's investigation. The responder told him to arrange for someone to keep his guns and to go to the VA emergency department. Miller stayed at the hospital for four days. In the discharge note, a nurse wrote that Miller asked to be released and that the "patient does not currently meet dangerousness criteria for a 72-hour hold." He was designated as "intermediate/moderate risk" for suicide. Although Miller had told the crisis hotline responder that he had access to firearms, several clinicians recorded that he did not have guns or that it was unknown whether he had guns. There was no documentation of clinicians discussing with Miller or his family how to secure weapons, according to the inspector general's report, a fact that baffles his father. "My son served his country well," said Greg Miller, his voice breaking. "But they didn't serve him well. He had a gun in his truck the whole time." Franklin, head of VA's suicide prevention program, called the suicide rate "beyond frustrating and heartbreaking," adding that it's essential that "local facilities develop a good relationship with the veteran, ask to bring their families into the fold - during the process and discharge - and make sure we know if they have access to firearms." She said VA is looking at ways to create a buddy system during the discharge process, pairing veterans who can support each other's recoveries. During the week of Miller's birthday in December, his family joined his high school band leader to donate Miller's trumpet to a local low-income high school. "He was a blue-chip, solid kid," said Richard Hahn, his high school band leader. "He does this honorable thing and goes into the Marines. Then we have this tragic ending." He sat with Miller's mother, Drinda, as she closed her eyes in grief, rocking gently. Hahn and Harrington recalled their memories of Justin, playing the trumpet at Harrington's wedding and taps at his grandfather's funeral. After the investigation into Miller's suicide, VA's mistakes were the subject of a September hearing in front of the House Veterans' Affairs Committee, but it was overshadowed by Brett Kavanaugh's testimony during his Supreme Court confirmation hearing. Listening to the conversation about her son, Drinda broke down and left the room. She sat in the lobby, shaky and crying. Her daughter knelt in her skirt to hold her mother's hand. A Rand Corp. study published in April showed that, while VA mental-health care is generally as good or better than care delivered by private health plans, there is high variation across facilities. "There are some VAs that are out of date. They are depressing," said Craig Bryan, a former Air Force psychologist and a University of Utah professor who studies veteran suicides, referring to problems with short staffing and resources. "Others are stunning and new, and if you walk into one that's awe-inspiring, it gives you hope." The Murfreesboro VA hospital, where Toombs took his life, was ranked among the worst in the nation for mental health, according to the agency's 2016 internal ratings. It has since improved to two out of a possible five stars. The program, "while nurturing in some ways, also has strict rules for picking up medications on time and attending group therapy," said Rosalinde Burch, a nurse who worked closely with Toombs in the VA program. She believes she was transferred and later fired from the program for being outspoken that "his death was totally preventable." Toombs was 20 minutes late to pick up medications the day he was kicked out, Burch said. He had been late several other times and occasionally left group sessions early, because he was suffering from anxiety. "But those shouldn't have been reasons for kicking him out," she said. "He was making real progress." Toombs' substance abuse screenings were clear, and he was starting to counsel other veterans, she said. Burch wrote an email to the hospital's program director, saying, "We all have the blood of this veteran on our hands." Since Toombs' death, the program has a new leadership team, including a new program chief and nurse manager, the hospital spokeswoman said. Burch has filed a complaint with the Office of Special Counsel, an independent federal agency that investigates whistleblower claims, to get her job back. For Miller's family, their son's death has motivated them to speak out about how VA can improve. "The VA didn't cause his suicide," Harrington said. "But they could have done more to prevent that, and that's just so maddening." On the snowy burial grounds behind St. Joseph of the Lakes Catholic Church in a quiet suburb of the Twin Cities, she huddled with her parents around his grave. Nearby stood the special in-ground trumpet stand that his father designed. The family sipped from a tiny bottle of Grand Marnier, a drink that Miller liked. His mother shook her head in despair as she recalled the sounds of her son's music. "Justin used to play his trumpet for all of the funerals," his father said. "But he wasn't here to play for his own." Local help available for Oregon veterans Anybody going through a mental health crisis should call the Mental Health Crisis Intervention Hotline at 503-988-4888 or 800-716-9769. Portland is home to Lines for Life, a
nonprofit devoted to suicide prevention throughout the
Pacific Northwest. It operates a suicide prevention line
that is answered 24 hours a day, 365 days a year. It can be
reached at 800-273-8255 or by texting "273TALK" to
839863. Military Suicide
Prevention Act Implemented by Armed Forces Military
Service Members and Veterans Among veterans, the suicide rate appears to have stabilized in recent years.2 But this rate remains unacceptably high. Recent estimates suggest that 22 veterans may die by suicide each day.2 To address this serious problem, the U.S. Department of Defense and the U.S. Department of Veterans Affairs have put into place comprehensive suicide prevention programs. Risk and Protective Factors Suicide prevention efforts seek to reduce risk factors for suicide and strengthen the factors that help strengthen individuals and protect them from suicide. Here are a few examples: Risk factors
Protective factors
References 1. U.S. Department of Defense. (2015). DoDSER Department of Defense Suicide Event Report: Calendar Year 2014 Annual Report. Retrieved from: www.dspo.mil/Portals/113/Documents/CY%202014%20DoDSER%20Annual%20Report%20-%20Final.pdf (153 page PDF) 2. Kemp J., Bossarte, R.
(2012). Suicide data report, 2012: Department of Veterans
Affairs Mental Health Services Suicide Prevention Program.
Retrieved from www.va.gov/opa/docs/suicide-data-report-2012-final.pdf
(59 page PDF) Fake
Navy SEALS SEALs take their name from the environments in which they are trained to operate: SEa, Air and Land (SEAL) Teams, commonly known as Navy SEALs. Hell week is a grueling five-and-a-half day stretch, each candidate sleeps only about four total hours but runs more than 200 miles and does physical training for more than 20 hours per day. www.sealswcc.com/navy-seals-videos.aspx Those who become bona fide SEALs wear a gold trident. There are just 2,500 on active duty, many serving in the world's most dangerous places. "There were about 500 SEALs that
operated in Vietnam, and I've met all 20,000 of them,"
Waterman joked. A short-list
of 43 of the hundreds of men claiming to be something
they're not cut out to be in their wildest dreams. Collected
from July 1, 2010 through April 21, 2011 at stolenvalor.com/target.cfm?source=link&sort=order
Find more "Fake
SEALs" and men who
claim to have been POWs
here.
Wounded Vets Told
to Repay Bonuses 17 Veteran Suicides
a Day Iraq Vets Face
Mental Challenges PTSD affecting 'a
quarter-million' Vietnam war veterans The study has implications for the future care of veterans of the Iraq and Afghanistan wars. The study by Dr. Charles Marmar, of the New York University Langone Medical Center, and colleagues estimates that around 15-17% of war veterans have had post-traumatic stress disorder (PTSD) at some point in their lifetime. The authors conclude there is an estimated 271,000 Vietnam veterans presently living with full PTSD, a third of whom have current major depressive disorder. The authors' National Vietnam Veterans Longitudinal Study builds on the National Vietnam Veterans Readjustment Study (NVVRS), which ran from 1984 through 1988. Of the 1,839 veterans from the original study, 1,450 (78.8%) participated in at least one phase of the new study, which ran from July 2012 to May 2013. The prevalence among male war-zone veterans for a current PTSD diagnosis varied by definition: 4.5% for a current PTSD diagnosis, based on the clinician-administered PTSD scale for the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" ("DSM-5") 10.8% against that assessment plus subthreshold PTSD (meeting some diagnostic criteria). 11.2% based on the PTSD checklist for "DSM-5" items for current war-zone PTSD. Among female veterans, these estimates were, respectively: 6.1%, 8.7% and 6.6%. Of the veterans with current war-zone PTSD, some 36.7 also had major depression. Other estimates were that about 16% of war-zone Vietnam veterans reported a rise of more than 20 points on a PTSD symptom scale; 7.6% reported a fall of the same size on the scale. Of this latter finding, the study authors say: "An important minority of Vietnam veterans are symptomatic after 4 decades, with more than twice as many deteriorating as improving." 'High-quality findings' In an editorial article published in the same issue of the journal, Dr. Charles Hoge, of the Walter Reed Army Institute of Research in Silver Spring, MD, writes: "This methodologically superb follow-up of the original NVVRS cohort offers a unique window into the psychiatric health of these veterans 40 years after the war's end. No other study has achieved this quality of longitudinal information, and the sobering findings tell us as much about the Vietnam generation as about the lifelong impact of combat service in general, relevant to all generations." "The study is of vital importance to
subsequent generations of war veterans and underscores
medical service needs for PTSD and related comorbidities
extending decades after service," the editorial
concludes. Suicidal
thinking affects 'significant minority' of US veterans The research, published in the Journal of Affective Disorders, used data from a nationally representative sample of over 2,000 American vets who were surveyed twice - once in 2011 and again in 2013 - in a study led by the Veteran's Affairs (VA) National Center for PTSD. Each time, the survey asked the veterans whether they had experienced suicidal thoughts in the past 2 weeks, and also about a host of other factors associated with suicidal thinking. The results showed that around 86% of participants reported having no suicidal thoughts in the previous 2 weeks at both times they were surveyed. However, within the 14% or so who did report having had suicidal thoughts on at least one of the two survey occasions, nearly 4% showed remitted suicidal thinking - that is, they reported having thought about suicide in 2011, but not in 2013. And 5% showed the opposite pattern - they reported having thought about suicide in 2013, but had not done so 2 years earlier. The researchers say this result highlights how suicidal thinking can come and go, at least within the span of a couple of years. This contradicts previous studies that suggest suicidal thinking tends to be a longer-term problem and emphasizes the need for continual monitoring of symptoms. The findings also reveal a need for more outreach support. Among participants who reported having thought about suicide in 2013, but not 2 years earlier, only 35% had ever received any mental health treatment. Social connectedness can be a buffer against suicide Not surprisingly, the results show higher levels of physical health problems, psychiatric distress and history of substance use were linked to chronic suicidal thinking. The findings also support the idea that social connectedness can be a buffer against suicide risk. It emerged as a factor in the 4% who showed remitted suicidal thinking, and among veterans who showed less social support in 2011, more were likely to report suicidal thoughts in 2013. However, the authors note that for many of the participants reporting chronic suicidal thinking, social support appeared to have little effect. For these veterans, the priority is likely to be psychiatric and physical health care, as well as help dealing with substance abuse. The researchers explain it is not easy to compare their figures with rates of suicidal thinking in the general population because studies on suicide vary widely in their methods. However, a study that it might be reasonable to compare with, is one from the Centers for Disease Control and Prevention (CDC) that found 3.7% of adults in the US report having thought about suicide in the previous 12 months. By that standard, the rate of suicidal thinking in veterans is high. This fits with other estimates that show while only 13% of adults in the US are veterans, they account for 22% of suicides, and that veterans are twice as likely to die from suicide as civilians. The authors acknowledge that 2 years is probably not long enough for this kind of study - it cannot draw conclusions about the longer term. Another potential weakness of the analysis is that around a third of the participants who responded in 2011 did not take part in 2013. If those who dropped out were the ones more likely to have suicidal thoughts, this could mean the estimates about suicidal thinking in veterans are too low. Nevertheless, the researchers say their findings suggest "a significant minority" of veterans in the US has chronic, onset or remitted suicide ideation (SI), and conclude: "Prevention and treatment efforts designed to mitigate psychiatric and physical health difficulties, and bolster social connectedness and protective psychosocial characteristics may help mitigate risk for SI." In July 2015, Medical News Today
learned that even 40 years after the end of the war, around
a quarter
of a million Vietnam veterans have
PTSD or some other form of
mental ill health. More
veterans are heading west to fight a new battle: Worsening
wildfires Sand and gravel crunched under the pounding boots of about 150 men and women walking and jogging on a recent rain-drenched morning at Paramount Ranch in the Santa Monica mountains. The wildland firefighter hopefuls were tackling a fitness test. They had to cover three miles of outdoor terrain with a 45-pound pack on their chests in less than 45 minutes. Firefighting instructor Sage Decker ran alongside the trainees. Decker helped fight the Lilac and Thomas fires in Southern California last year, one of thousands of firefighters who came from all over the country to respond to a record fire season in the state. Some, like Decker, had faced difficult battles before: they were military veterans who transitioned from service in the armed forces to battling wildfires. When Decker first got out of the army in 2000, he had trouble finding a career that provided the fulfillment of military service. “I was looking for jobs and I was doing some carpentry stuff,” he said. “I just wasn’t really happy with that.” Decker’s brother hooked him up with a fire crew in Wyoming, and it stuck: he now has 16 years of wildfire response under his belt. “I think it’s a really good route to go. It provides stability, and just a good brotherhood,” he said. Between fire seasons, he travels the country providing training through a program with the Bureau of Land Management and Team Rubicon, a non-profit veteran service organization that responds to natural disasters worldwide. With firefighting, veterans “have a group of people that they’re with all the time, similar to a platoon or a battalion, Decker said. “We deploy together. Military service translates really well into work on a fire line.” Veterans who complete the Team Rubicon-BLM course earn their Wildland Firefighter Type II certification, allowing them to mobilize to assist federal agencies in responding to fire and to be paid as firefighters. Fire agencies are looking to recruit more veterans like Decker, said John Asselin, spokesman with the BLM. “Now we’re getting fires that are lasting longer into the year past the season, like the fires that were out here in December,” Asselin said. “So it’s really important that we have a pool of trained wildland firefighters.” Then-Interior Secretary Sally Jewell first announced the Team Rubicon-BLM partnership in 2015. Jewell and Agriculture Secretary Tom Vilsack stressed the growing threat of catastrophic wildfires due to climate change and drought, and the need for federal agencies to strengthen the available workforce required to safely contain increasingly ferocious wildland fires in Western states. To date, Team Rubicon and BLM have trained more than 900 firefighters. This year the program is significantly expanding: it’s on course to reach a total of nearly 2,000 trained wildland firefighters by the end of 2018. Organizers say military veterans are a logical resource for fire agencies because they’re accustomed to the physical challenges of working long hours on tough terrain. “It’s unique fire fighting, because it’s not the same as fighting a structure fire,” Asselin said. “This is a much bigger area. It’s wildland fire, so it’s a huge area where you have to put large perimeters up.” “Wildland firefighting is physically one of the toughest things you can do,” said Jason Boeshore, Veterans Program Coordinator with the non-profit Conservation Legacy Southwest Conservation Corps in Durango, Colorado. Boeshore recently took over the Veterans Fire Corps and Veterans Conservation Corps programs, developed to help returning servicemembers transition to civilian life by providing skills training and career connections in conservation and firefighting. Boeshore deployed to Afghanistan with the Missouri Army National Guard and worked route clearance—detecting and digging up bombs near the Afghan-Pakistan border. “Once you endure the stress of combat, fire’s not so bad,” he said. Veterans Fire Corps teams live and working in the field, learning wildland firefighting 101: the basics of using chainsaws and hand tools to create a fire line, and wilderness first aid. Boeshore said most of the veterans spend two 6-month seasons with the Corps, then move on to join a fire crew somewhere else in the country. The priority is employment. “We have so many veterans out there that just need meaningful careers," Boeshore said, adding the Veterans Fire Corps is also growing this year. “I have a lot of guys coming into this program that are jobless and homeless.” Veterans experience a lot of the things they miss from military life within the structure of firefighting crews, Boeshore said. “Veterans need camaraderie. They need to be part of a team. And when you’re working in forestry, especially in fire, that’s what you get,” he said. “There’s a chain of command. There’s a hierarchy. There are specific missions.” That sense of mission is what drew Marine Corps veteran Tomas de Oliveira to Team Rubicon’s wildland firefighting training. He lined up with fellow students getting sized for fire retardant pants, shirts, and gloves in high-visibility yellow. “I just always feel like I want to do more for people who find themselves in probably the worst day of their lives,” de Oliveira said. “I figured helping to fight the fires that we tend to have in California yearly would be a good way to do that.” In the Marines, de Oliveira spent years working embassy security around the world. He’s now a reservist. Last year he was part of the Team Rubicon response teams helping with Hurricane Harvey recovery in Texas. De Oliveira’s not sure about going into firefighting as a career path, but he said he thought the chainsaw skills will be useful in future disaster responses. Overseeing the gear-fitting was Michael Lloyd, the National Wildland Firefighter Program Manager for Team Rubicon. He emphasized the need to assist veterans during the transition to civilian life, something he encountered firsthand as a veteran of Desert Storm and Desert Shield. Transition assistance was virtually nonexistent when he left the Navy in the 1990s. “It was hard. It took a couple of years to kinda get your bearing again, and to find that foundation of what your life was post-military,” Lloyd said. “Fighting fires exercises all those things that you really got used to in the military that you lost when you come out into civilian life.” Successful rookies will get their
‘red cards’—another name for the Wildland
Firefighting Type II certification—by the end of the
four-day training. New
resources to help Veterans understand lethal means
safety The Reducing Firearm & Other Household Safety Risks for Veterans and Their Families brochure provides best practices for safely storing firearms and medications, along with advice for Veterans’ loved ones on how to talk to Veterans about safe storage. The Means Safety Messaging for Clinical Staff pocket card provides medical professionals with easily digestible information for talking with Veteran patients about safe storage. Clinicians looking for more information on speaking to Veteran patients can read the From Science to Practice review on how lethal means safety saves lives. These resources are designed to help
Veterans, their loved ones, and the supporting clinicians
find the safe storage option that aligns with the
Veteran’s values and priorities. A new stamp to
help raise money for veterans who deal with post-traumatic
stress disorder The main feature of the stamp is a green plant sprouting from the ground surrounded by fallen leaves. USPS says the image is meant "to symbolize the PTSD healing process." “The Postal Service is honored to issue this semipostal stamp as a powerful symbol of the healing process, growth and hope for tens of millions of Americans who experience PTSD,” said USPS Board of Governors vice chairman David C. Williams. "Today (020320), with the issuance of this stamp, the nation renews its commitment to raise funds to help treat soldiers, veterans, first responders, health care providers and other individuals dealing with this condition.” USPS says the Healing PTSD semipostal stamp is being sold for 65 cents. The price includes First-Class Mail single-piece postage rate in effect at the time of purchase, plus an amount to fund PTSD research. "By law, revenue from sales of the Healing PTSD semipostal stamp — minus the postage paid and the reimbursement of reasonable costs incurred by the Postal Service — will be distributed to the U.S. Department of Veterans Affairs," USPS said in a press release. The stamp was issued on Dec. 2 during
a dedication event at McGlohon Theater at Spirit Square in
Charlotte, North Carolina. Suicide
Rate Spikes in Vietnam Vets Who Won't Seek Help Every Christmas Rudi Gresham, a former combat soldier in Vietnam, gets a Christmas card from a fellow veteran who was nearly pushed to the brink of suicide because of despair. "The guy was in his late 50s and his wife had left him and he came down with cancer from Agent Orange, he was broke and he had to move in with his mom and dad--he didn't know where to go from there," said Gresham, who was then serving as senior advisor to the Department of Veterans Affairs under the George W. Bush administration. "Everything had gone to hell," said Gresham. "But I communicated with him." Now 68 and retired in South Carolina, Gresham was able to get the veteran the 10 years of back pay he deserved by authenticating his service with a commanding officer. Today, the man's cancer is under control and he has a new woman in his life. Gresham said getting that thank you card for saving the veteran's life was "the most gratifying moment" in his eight-year career with the VA. "I tell my kids, this is the reward for my work." But three other depressed friends were not so lucky and took their own lives, becoming statistics in a rising tide of suicides among baby boomers, many of them Vietnam War veterans. Just this week the Centers for Disease Control and Prevention (CDC) released its latest statistics on suicide rates among Americans, finding that the number of middle-aged Americans who took their own lives was up more than 28 percent. Annual suicide rates among U.S. adults aged 35 to 64 increased from 13.7 to 17.6 suicides per 100,000 people between 1999 and 2010. The greatest increases in suicide rates were among people aged 50 to 54 years (48 percent) and 55 to 59 years (49 percent). For the whole population, the national rate was 12.4 per 100,000 in that decade, according to the CDC. The most common mechanisms were suffocation or hanging, poisoning and firearms. Increases were seen among both men and women. The CDC cites the recent economic downturn, a "cohort effect" among baby boomers who had unusually high suicide rates during their adolescent years, and a rise in intentional overdoses because of increased availability of prescription opiods. But suicide rates among Vietnam veterans are the highest of any particular group, according to John Draper, project director of the National Suicide Prevention Lifeline. Eight million Americans report suicidal thoughts, and 1.1 million will attempt suicide. An estimated 38,000 will succeed in killing themselves, according to the CDC. Most are male, by a four to one margin, and are single and lack a college education. The suicide rate jumped higher for women (32 percent) than for men (27 percent). "Men tend to be more lonely and have a harder time maintaining and replacing relationships than women, especially when they get into middle age," said Draper. "Men are busy working or tie their relationships to work and when they lose their job, they lose their relationships." Those who are less stable in their personal lives are also less stable in the workforce, he said. "I don't have all the answers," said Draper. "But we know about suicide prevention and people who are more socially connected and have a sense of belief and self-worth and are valued at work and in their relationships are way more protected and generally happier people." Post-traumatic stress disorder and associated mental health problems are to blame for many of the suicides among war veterans, according to Draper. "The most important thing to remember is we can do something to stop this," said Draper, who, like Gresham, said that communication and support from others can help to prevent suicide. Since 2001, more than two million service members have been deployed to wars in Iraq and Afghanistan. The cost for treating veterans of all eras and conflicts is estimated at $48 billion, according to the Department of Veterans Affairs. PTSD was not even recognized until after the Vietnam War, according to Gresham, who recognized at the onset of his government career in 2000 the importance of increasing the VA budget after predicting the staggering number of cases that were to follow. "I knew mental problems would exceed the physical," he said. "I feel sorry for the younger soldiers," he said. "They are now married, got a wife and kids and suddenly come back and they can't find a job. These things all compound." As for the Vietnam veterans, they found less support in the 1960s and 1970s, when they returned from combat service. "The older veterans don't trust the government and they don't go for help," said Gresham. Unlike World War II soldiers who were hailed as heroes, these servicemen returned to "feel a bit outcast and rejected," according to Gresham, who sits on the Vietnam Veterans Foundation. Many of that generation refused to acknowledge they had PTSD and are suffering the consequences later in life. "Believe me, we have a real problem," he said. "These guys were the first generation not to trust the guys in the white coats, and they didn't trust the government," said Gresham. "A lot of the Viet vets with PTSD held it in. "They didn't want to let their family know their dark secret. They wanted to be in the workforce and be productive like the generation of World War II, but they were not respected by society." The VA in the 1970s was not responsive to the needs of these veterans, he said. "I've seen what has happened to a lot of these older vets." At a town meeting in Los Angeles several years ago, Gresham said he told a group of Vietnam vets. "You know Hollywood was correct when they did the movie the 'Fourth of July' with Tom Cruise. The VA did a lousy job of taking care of vets." But today, according to Gresham, "The VA has made "tremendous efforts to spend lots of money on [PTSD]," he said. In 2007, the VA partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a dedicated line manned by veterans on the National Suicide Lifeline. The so-called Veterans Crisis Line has fielded more than 250,000 calls a year from veterans and active members of the military, according to Lifeline director Draper. "It's a brilliant idea and it's saved taxpayers money and saved lives," he said. Draper said it is too early to see the impact of this collaboration but predicts that CDC suicide numbers will eventually drop, at least among veterans. Gresham, who was involved in the creation of the hotline, is also hopeful. "It's so much better for veterans to get help from other veterans," he said. "There is a strong bond." "If you have suicide thoughts and there's another veteran on the line, you trust your brother, whether it's a man or a woman," he said. "If they have been in combat, there is someone who understands you." "They didn't trust the VA for a long time and now the VA has its arms open," said Gresham. "They do very good work now. They understand the problem." If you or a loved one are in emotional
distress, please call the National Suicide Prevention
Lifeline at 1-800-273-8255 Veterans should press option 1 or
text SOS to 741741. We are here to help 24/7. You are
not alone. Help is available. VSOs to Congress:
Act on toxic exposure, women vets’ care, TBIs and
suicide prevention One after another, leaders of Wounded Warrior Project, Blinded Veterans Association, Jewish War Veterans, Vietnam Veterans of America, the Military Order of the Purple Heart, AMVETS and more -- many of them veterans themselves -- appealed to lawmakers to ensure veterans receive the care and support they earned through service. Suicide prevention WWP CEO Michael Linnington asked lawmakers at a joint hearing of House and Senate Veterans Affairs committees to approve more funds for suicide prevention programs in the communities where veterans live and work and enhance research capabilities for post-traumatic stress disorder and traumatic brain injuries to prevent suicide. More than 83 percent of Wounded Warriors report experiencing PTSD and more than one-third of Wounded Warriors say they’ve thought about suicide within two weeks, Linnington said. About 20 veterans die by suicide daily, according to VA. Linnington said a suite of WWP programs help veterans reconnect with one another. "Isolation," he said, "is a killer." Some VSO leaders were visibly frustrated by a lack of progress. AMVETS National Commander Jan Brown said Congress and VA need to look to new and different mental health approaches, calling the current system “horribly broken.” “How are we ever going to get a handle on this problem if we are spending more than 90 percent of our resources on approaches that fail?” she said, adding that AMVETS recommends Congress funnel any and all increases in VA’s mental health budget to “alternative, novel and non-pharmacological approaches” such as recreational therapy and yoga or community providers and programs. “We need to stop doing the same actions and expecting fewer deaths.” We want to help the VA create a culture that proactively seeks out lonely, homeless, family-less, disaffected veterans and brings them in from the cold,” VVA National President John Rowan said. Toxic exposure Toxic exposures have affected U.S. service members for generations, and last year Congress made some progress in providing benefits to more Vietnam veterans exposed to Agent Orange. But there’s more work to do for those aging veterans, along with veterans of more recent conflicts such as Operations Desert Storm and Shield and the wars in Iraq and Afghanistan, especially burn pits. “The Departments of Defense and Veterans Affairs maintain that any ill effects from exposure to burn pits is temporary and will pass once the military member is removed from the area,” JWV National Commander Harvey Weiner said. “However, these denials have a familiar ring to them in the minds of the Vietnam veterans and their issues with the military’s denial of any ill effects of Agent Orange and other herbicides.” “VA more often than not put up roadblocks to veterans suffering with illnesses (from burn pits),” Rowan said. “It was deja vu all over again. This is wrong … Toxic exposures can be ... as deadly ... as piercing wounds from bullets and bombs.” Linngton asked Congress to make lifesaving treatment for toxic exposure-related illnesses a new priority group at VA, develop a strategy for VA and the Pentagon to work together to update its exposure records and find high-risk vets, ensure veterans can access their own exposure records and more. Weiner, along with other VSO leaders, called on Congress to order VA to extend Agent Orange benefits to cover additional diseases linked to the toxic herbicide that VA has so far resisted. Veterans also fear how their exposures could be passed to their children, Rowan said. “We fear the epigenetic impact of our exposures on those we love the most,” he said. TBI TBIs have repeatedly been referred to as the invisible wounds of war, but the number of veterans with these brain injuries is growing. Nearly 40 percent of Wounded Warriors said they had a TBI during service. VSO leaders appealed to Congress to require VA to provide fully supportive programs and resources for those veterans and ensure the injuries are tracked, documented, treated and researched. Thomas Zampieri of BVA, said that TBIs, which affected more than 413,000 veterans over the last 19 years, “can have significant impact on vision -- even when there is no injury to the eye” and about 75 percent of veterans who had a TBI also experienced vision issues. “VA continues to see increased enrollment of this generation with various eye and vision disorders resulting from complications of frequent blast-related injuries,” he said. “PTSD and TBI can have considerable impact on quality of life and daily functioning, and if left untreated, both are risk factors that may increase the likelihood of suicidal ideation, planning, and attempt,” Linnington warned, adding that TBI patients are at increased risk for homelessness, incarceration and institutionalization, “all of which are unacceptable outcomes.” Women veterans Women are the fastest-growing demographic among veterans and more than 44 percent of women Wounded Warriors say they experienced military sexual trauma during service, and according to the Defense Department, that number is growing. One in four women veterans at VA also screen positive for MST. “Those who live with MST in their past have experienced the ultimate betrayal by a fellow service member,” Linnington said. “They deserve easy access to high quality, gender-sensitive care furnished by VA.” VSO leaders asked Congress to support existing programs and services to provide compassionate and comprehensive care to MST survivors. To help women veterans access VA care, advocates asked Congress to instruct VA to extend its hours and expand and make permanent a pilot program to provide childcare to veterans who have appointments -- since women veterans are more likely to be single parents or the primary caregiver. In particular, advocates called for an increase in staff at VA medical centers who are qualified to treat women’s specific needs, especially in light of reports that some VA health systems have gone years without that staff. “There are many improvements to be made at VA to make women veterans feel welcomed and safe,” Brown said. Brown also referenced the alleged sexual assault of a woman veteran and senior congressional policy advisor at the Washington, D.C. VA hospital and the controversy surrounding how that case was handled, which she called “a victim-blaming fiasco.” Disabled American Veterans call on Congress to tackle toxic exposure, suicide prevention, women vets’ care If you or someone you know needs help, contact the Veteran Crisis Line 24/7 at 1-800-273-8255 (select option 1 for a VA staff member). Veterans, service members or their families also can text 838255 or go to veteranscrisisline.net. Reach Abbie Bennett: abbie@connectingvets.com or @AbbieRBennett. Want to get more connected to the
stories and resources Connecting Vets has to offer? Click
here to sign up for our weekly newsletter. Q&A 400,000 people In addition to the massive environmental devastation of the U.S. defoliation program in Vietnam, that nation has reported that some 400,000 people were killed or maimed as a result of exposure to herbicides like Agent Orange.May 16, 2019 What are the 14 diseases associated with Agent Orange? Currently, the list of health conditions associated with Agent Orange exposure includes the following:
What health problems did Agent Orange cause? 3. VA has linked several diseases and health conditions to Agent Orange exposure.
Can Agent Orange cause mental illness in offspring? VA does not explicitly say that these birth defects are due to Agent Orange exposure, only that they are connected to military service during the Vietnam War. Additionally, “the birth defect must have resulted in permanent physical or mental disability” in order to qualify for benefits.Apr 18, 2017 Can Agent Orange be passed to offspring? The military later admitted Agent Orange caused cancer and other health problems for vets. In 1996 they even admitted it could be passed down to the children of vets and awarded them ben Can Agent Orange cause mental illness in offspring? VA does not explicitly say that these birth defects are due to Agent Orange exposure, only that they are connected to military service during the Vietnam War. Additionally, “the birth defect must have resulted in permanent physical or mental disability” in order to qualify for benefits.Apr 18, 2017 Is Agent Orange still used? Agent Orange was a herbicide mixture used by the U.S. military during the Vietnam War. Much of it contained a dangerous chemical contaminant called dioxin. Production of Agent Orange ended in the 1970s and is no longer in use. ... The chemical dioxin in Agent Orange can remain toxic in the soil for decades What are Agent Orange benefits? The VA offers health care and disability benefits for veterans who may have been exposed to Agent Orange and other herbicides during military service. Your dependents and survivors also may be eligible for benefits. If you were exposed to Agent Orange between Jan.Jun 3, 2020 What is the life expectancy of a Vietnam veteran? Your going it make to 90. Your doing
good for an old man! A report in 1999 shows Australian
Vietnam Veterans life expectancy at 56 years. For US Vietnam
Veterans it's about 66 years vs just about 78 years for non
vets. V.A. says it is
taking action to stem suicides, help Blue
Water Navy vets on
benefits The numbers are staggering: 20 military veterans commit suicide every day in America. In 2017, more than 6,100 took their own lives. The rate of veterans dying at their own hand is 1.5 percent higher than it is for non-veteran adults. For the Department of Veterans Affairs, one big challenge is figuring out what to do about the veterans who are not affiliated with the V.A. who commit suicide daily. How does the department reach them? The V.A. is introducing a new program called "Solid Start." It is designed to help departing active and reserve troops as they transition to civilian life. It's part of the larger effort to combat suicide being led by the V.A.'s Under Secretary for Benefit, Dr. Paul Lawrence. "Two-thirds of the veterans who commit suicide have never come to the V.A.," he said. "Solid Start is a series of phone calls in the first year as they transition to civilian life, to begin to establish the relationship and connect them with the V.A. Don't forget, once you leave the military, you're a veteran forever. And we want veterans to know you're welcome at the V.A." The program is a part of Executive Order 13-822, which aims to improve mental health care and access to suicide prevention resources to service members following discharge, separation or retirement from the military. An estimated 200,000 veterans each year will be contacted around 90, 180 and 365 days after leaving service. The program wants to connect veterans with direct benefits and partner organizations that can help them in the transition period. Veterans discharged within the past two months have been automatically signed up. "So far it''s been a great success," said Lawrence. "We've actually connected with a much higher level. And quite frankly, we've had some anecdotes of changing people's lives; they've been lonely and the like, and this has helped them re-frame and get to a much more positive place." Anyone interested in the program or who wants to sign up can call 1-800-827-0611 for more information. Another issue challenging the V.A. has been helping Vietnam War Blue Water Navy veterans exposed to the toxic chemical Agent Orange. Last week, a group of 38 lawmakers sent a letter to the White House complaining that the V.A. has been to slow to approve benefits for the estimated 190,000 vets who may have been exposed. The senators said the V.A. was "stonewalling" when it comes to approving 14 different types of cancer that are presumed to have been caused by Agent Orange. Not so, says Lawrence. He said the department has been diligent preparing for the new coverages as mandated by the Congress, signed by the president and which went into effect January 1, 2020. "We spent the period from June to January getting all the ships logs of the 1,900 ships that were in the Navy at that time from the National Archives, and scanning them, and building electronic tools to do that," he said. "So, if you have the conditions and you were in the Navy, please come and apply and we'll figure out if you're eligible for benefits and care." You can begin the process by going to
VA.gov. Postservice
Mortality Among Vietnam Veterans In 2004, an update of the 1987 mortality study was published. This follow-up study further assessed the health effects of the Vietnam experience on cause-specific mortality, especially chronic conditions. It compared mortality rates between Vietnam veterans and veterans who did not serve in Vietnam. Vital status and underlying cause of death were retrospectively ascertained from the end of the original study in 1983 through 2000. Data were analyzed using Cox proportional hazards regression to factor in the effects of multiple risk factors on survival. Death from all causes was slightly higher among Vietnam veterans than non-Vietnam veterans over the entire follow-up period. Despite the increasing age of the study group (mean = 53 years) and longer follow-up period (average 30 years), death rates from disease-related conditions, including cancers and circulatory system diseases, did not differ between Vietnam veterans and their peers. Vietnam veterans continued to experience higher mortality than non-Vietnam veterans from unintentional poisonings and drug-related causes. Publications Postservice Mortality among Vietnam Veterans This report presents results of the mortality component of the Vietnam Experience Study (VES). Part 1 Cdc-pdf[PDF – 2.92 MB] (58 page PDF) Part 2 Cdc-pdf[PDF – 2.65 MB](69 page PDF) The Centers for Disease Control Vietnam Experience Study. Postservice mortality among Vietnam veterans. Journal of the American Medical Association 1987;257:790–5. Catlin TK, Flanders WD, McGeehin MA,
Boyle CA, Barrett DH. Postservice mortality among Vietnam
veterans: 30-year follow-up. Archives of Internal Medicine
2004;164:1908–16. 8
ways veterans are particularly at risk from the coronavirus
pandemic Among the most hard-hit (22 page PDF) are veterans, who are particularly susceptible to both health and economic threats from the pandemic. These veterans face homelessness, lack of health care, delays in receiving financial support and even death. I have spent the past four years studying veterans with substance use and mental health disorders who are in the criminal justice system. This work revealed gaps in health care and financial support for veterans, even though they have the best publicly funded benefits in the country. Here are the eight ways the pandemic threatens veterans: 1. Age and other vulnerabilities In 2017, veterans’ median age was 64; their average age was 58 and 91% were male. The largest group served in the Vietnam era, where 2.8 million veterans were exposed to Agent Orange. Younger veterans deployed to Iraq and Afghanistan were exposed to dust storms, oil fires and burn pits, and perhaps as a consequence have high rates of asthma and other respiratory illnesses. Age and respiratory illnesses are both risk factors for COVID-19 mortality. As of April 13, 241 patients in Veterans Administration health care facilities had died of COVID-19 and 4,000 have tested positive. 2. Dangerous residential facilities Veterans needing end-of-life care, those with cognitive disabilities, or those needing substance use treatment often live in crowded VA or state-funded residential facilities. State-funded “Soldiers’ Homes” are notoriously starved for money and staff. The horrific situation at the Soldier’s Home in Holyoke, Massachusetts, where more than 40 veteran residents have died from a COVID-19 outbreak, illustrates the risk facing the veterans in residential homes. 3. Benefits unfairly denied When a person transitions from active military service to become a veteran, they receive a Certificate of Discharge or Release. This certificate provides information about the circumstances of the discharge or release. It includes characterizations such as “honorable,” “other than honorable,” “bad conduct” or “dishonorable.” These are crucial distinctions, because that status determines whether the Veterans Administration will give them benefits. Research shows that some veterans with discharges that limit their benefits have PTSD symptoms, military sexual trauma or other behaviors related to military stress. Veterans from Iraq and Afghanistan have disproportionately more of these negative discharges than veterans from other eras, for reasons still unclear. VA hospitals across the country are short-staffed and don’t have the resources they need to protect their workers. AP/Kathy Willens The Veterans Administration frequently and perhaps unlawfully denies benefits to veterans with “other than honorable” discharges. Many veterans have requested upgrades to their discharge status. There is a significant backlog of these upgrade requests, and the pandemic will add to it, further delaying access to health care and other benefits. 4. Diminished access to health care Dental surgery, routine visits and elective surgeries at Veterans Administration medical centers have been postponed since mid-March. VA hospitals are understaffed – just before the pandemic, the VA reported 43,000 staff vacancies out of more than 400,000 health care staff. Access to health care will be even more difficult when those medical centers finally reopen. As of Monday, April 13, 1,520 VA health care workers have tested positive for COVID-19, and thousands of health care workers are under quarantine. The VA is asking doctors and nurses to come out of retirement to help already understaffed hospitals. 5. Mental health may get worse An average of 20 veterans commit suicide every day. A national task force is currently addressing this scourge. But many outpatient mental health programs are on hold or being held virtually. Some residential mental health facilities have closed. Under these conditions, the suicide rate for veterans may grow. Suicide hotline calls by veterans were up by 12% on March 22, just a few weeks into the crisis. 6. Complications for homeless veterans and those in the justice system An estimated 45,000 veterans are homeless (a national disgrace) on any given night, and 181,500 veterans are in prison or jail. Thousands more are under court-supervised substance use and mental health treatment in Veterans Treatment Courts. More than half of veterans involved with the justice system have either mental health problems or substance use disorders. As residential facilities close to new participants, many veterans eligible to leave prison or jail have nowhere to go. They may stay incarcerated or become homeless. Courts are moving online or ceasing operations altogether. It is unclear whether participants will face delays graduating from court-supervised treatments. Further, some Veterans Treatment Courts still require participants to take drug tests. With COVID-19 circulating, participants must put their health at risk to travel to licensed testing facilities. As veterans’ facilities close to new participants, many veterans eligible to leave prison or jail have nowhere to go and may become homeless, like this Navy veteran in Los Angeles. Getty/Mario Tama 7. Disability benefits delayed In the pandemic’s epicenter in New York, tens of thousands of veterans should have access to VA benefits because of their low income – but don’t, so far. The pandemic has exacerbated existing delays in finding veterans in need, filing their paperwork and waiting for decisions. Ryan Foley, an attorney in New York’s Legal Assistance Group, a nonprofit legal services organization, noted in a personal communication that these benefits are worth “tens of millions of dollars to veterans and their families” in the midst of a health and economic disaster. All 56 regional Veterans Administration offices are closed to encourage social distancing. Compensation and disability evaluations, which determine how much money veterans can get, are usually done in person. Now, they must be done electronically, via telehealth services in which the veteran communicates with a health care provider via computer. But getting telehealth up and running is taking time, adding to the longstanding VA backlog. Currently, approximately 75,000 veterans wait more than 125 days for a decision. (That is what the VA defines as a backlog – anything less than 125 days is not considered a delay on benefit claims.) 8. Obstacles to getting stimulus checks Veterans with the greatest financial need may not automatically receive their stimulus checks. Currently, those living on tax-exempt income from the VA must file a tax return to get a check. But e-filing a tax return is a significant obstacle for many, especially severely disabled veterans who may not have computers or know how to use e-file software. There are many social groups to pay attention to, all with their own problems to face during the pandemic. With veterans, many of the problems they face now existed long before the coronavirus arrived on U.S. shores. But with the challenges posed by the situation today, veterans who were already lacking adequate benefits and resources are now in deeper trouble, and it will be harder to answer their needs. [You’re smart and curious
about the world. So are The Conversation’s authors and
editors. You
can get our highlights each weekend.] National
Roadmap to Empower Veterans and End Suicide Section 1. Purpose. On average, 20 service members and veterans die by suicide each day. As a Nation, we must do better in fulfilling our solemn obligation to care for all those who have served our country. I am therefore issuing a national call to action to improve the quality of life of our Nation's veterans—many of whom have risked their lives to protect our freedom while deployed, often multiple times, to areas of prolonged conflict. Answering this call to action requires an aspirational, innovative, all-hands-on-deck approach to public health—not government as usual. The Federal Government alone cannot achieve effective or lasting reductions in the veteran suicide rate. This is not because of a lack of resources. It is, in fact, due substantially to a lack of coordination: Nearly 70 percent of veterans who end their lives by suicide have not recently received healthcare services from the Department of Veterans Affairs. To reduce the veteran suicide rate, the Federal Government must work side-by-side with partners from State, local, territorial, and tribal governments—as well as private and non-profit entities—to provide our veterans with the services they need. At the same time, the Federal Government must advance our understanding of the underlying causal factors of veteran suicide. Our collective efforts must begin with the common understanding that suicide is preventable and prevention requires more than intervention at the point of crisis. The Federal Government, academia, employers, members of faith-based and other community, non-governmental, and non-profit organizations, first responders, and the veteran community must all work together to foster cultures in which veterans and their families can thrive. The United States must develop a comprehensive national public health roadmap for preventing suicide among our Nation's veterans, with the aspiration of ending veteran suicide once and for all. This roadmap must be holistic and encompass the overall health and well-being of our Nation's veterans. Sec. 2. Policy. It is the policy of the United States to end veteran suicide through the development of a comprehensive plan to empower veterans and end suicide through coordinated suicide prevention efforts, prioritized research activities, and strengthened collaboration across the public and private sectors. This plan shall be known as the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide or PREVENTS (the “roadmap”). Sec. 3. Establishment of the Veteran Wellness, Empowerment, and Suicide Prevention Task Force. (a) There is hereby established the Veteran Wellness, Empowerment, and Suicide Prevention Task Force (Task Force), co-chaired by the Secretary of Veterans Affairs and the Assistant to the President for Domestic Policy (Co-Chairs). (b) In addition to the Co-Chairs, the Task Force shall include the following officials, or their designees:
Sec. 4. Additional Invitees. As appropriate and consistent with applicable law, the Co-Chairs may, from time to time, invite the heads of other executive departments and agencies, or other senior officials in the White House Office, to attend meetings of the Task Force. Sec. 5. Development of the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide. (a) Within 365 days of the date of this order, the Task Force shall develop and submit to the President the roadmap to empower veterans to pursue an improved quality of life, prevent suicide, prioritize related research activities, and strengthen collaboration across the public and private sectors. The roadmap shall analyze opportunities to better harmonize existing efforts within Federal, State, local, territorial, and tribal governments, and non-governmental entities. The roadmap shall include:
(b) In developing the roadmap, the Co-Chairs shall, at their discretion and in consultation with the other members of the Task Force, engage with:
Sec. 6. State and Local Action. Within 365 days of the date of this order, the Task Force shall submit a legislative proposal to the President through the Director of the Office of Management and Budget that establishes a program for making grants to local communities to enable them to increase their capacity to collaborate with each other to integrate service delivery to veterans and to coordinate resources for veterans. The legislative proposal shall promote the development of milestones and metrics in pursuit of:
Sec. 7. Development of a National Research Strategy. (a) Within 365 days of the date of this order, the Task Force shall, in coordination with the Director of the Office of Science and Technology Policy, develop a national Start Printed Page 8587research strategy to improve the coordination, monitoring, benchmarking, and execution of public- and private-sector research related to the factors that contribute to veteran suicide. (b) As the Task Force develops this national research strategy, the Co-Chairs may, at their discretion and in consultation with the other members of the Task Force, engage with the persons and entities described in section 5(b)(i) through (iii) of this order, as well as with Federal Government entities. (c) The national research strategy shall include milestones and metrics designed to:
(d) The national research strategy shall not be limited to clinical or healthcare interventions, but should approach the problem of veteran suicide in a holistic manner to improve overall veteran quality of life. Sec. 8. Administrative Provisions. (a) The Department of Veterans Affairs shall provide funding and administrative support as may be necessary for the performance and functions of the Task Force. (b) The Secretary of Veterans Affairs, in consultation with the Assistant to the President for Domestic Policy, shall designate an official of the Department of Veteran Affairs to serve as Executive Director of the Task Force, responsible for coordinating its day-to-day functions. As necessary and appropriate, the Co-Chairs may afford the other members of the Task Force an opportunity to provide input into the decision of whom to designate as Executive Director. Sec. 9. Termination of the Task Force. After submission of the roadmap described in section 5 of this order, the Task Force established in section 3 of this order shall monitor implementation of the roadmap. The Task Force shall terminate 2 years following the submission to the President of the roadmap. Sec. 10. General Provisions. (a) Nothing in this order shall be construed to impair or otherwise affect:
Start Printed Page 8588 (c) This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person. THE WHITE HOUSE, March 5, 2019. Filed
3-7-19; 11:15 am] VA
partners with OnStar to prevent Veteran suicide.
In-vehicle system helped prevent potential suicide VA health systems specialist Dr. Jamie Davis was working with a Veteran who reported that her spouse, also a Veteran, was out driving and reported that he did not want to live. “He wouldn’t tell her where he was, go to the VA, or meet her anywhere,” said Davis. “When asked about locating him through her phone’s GPS, she said his car was OnStar-equipped. We called OnStar. Police were able to coordinate with OnStar to locate him and bring him in safely for an evaluation.” The story’s happy ending inspired Davis to contact OnStar to develop an official partnership with VHA after she joined the Office of Community Engagement (OCE). OCE facilitates and manages non-monetary partnerships with nongovernmental organizations. It works to improve the quality of life for Veterans, their families, caregivers and survivors. Transfer to VA crisis line The partnership became official this year. It will help connect Veterans in crisis with mental health assistance using OnStar’s in-vehicle emergency services button or its smartphone app. Veterans who contact OnStar because of a mental health crisis can be transferred to VA’s Veterans Crisis Line (VCL), a 24/7 hotline that is staffed by trained responders, many of whom are Veterans themselves. Through the partnership, VA will provide resources and education to OnStar about suicide prevention, military culture and how to determine if the caller has served in the military. Additional partnership objectives include providing training to VA clinicians and OnStar call center staff to facilitate suicide prevention efforts for Veterans. They’ll also explore opportunities for how to use OnStar tools, techniques and services to improve access to suicide prevention resources. VA clinicians, for example, will ask at-risk Veterans if they have OnStar. They will include that information in a Veteran’s suicide prevention safety plan as a resource should the Veteran experience emotional distress or a suicidal crisis. Advisors trained to help with a mental health crisis “OnStar’s emergency-certified advisors train to help people who have a mental health crisis,” said Ann Maher. Maher is assistant manager of emergency service and technology at OnStar. For Veterans who wish to speak to a crisis line responder, OnStar will provide a “warm hand-off” to VCL. “We’re not going to conference you in and then hang up. We’re going to stay connected and let the VCL know what’s going on. To bridge all the parties together. We will remain in the background until the person who called in or the crisis counselor determines we’re no longer needed.” Requires a paid OnStar subscription OnStar safety and security devices require a trial or paid subscription plan and are available on most General Motors vehicles. Additionally, OnStar’s Guardian smartphone app allows members with active service plans and up to seven family members or friends access from their phones. The app also has an emergency services button, which can help OnStar advisors locate members in distress. Members can also choose to share their locations with each other within the app. Suicide prevention is the top clinical priority for VA. Educating partners about suicide prevention and intervention for Veterans is a cornerstone of any partnership VA pursues. Davis said the partnership has the potential to help any Veteran who is in crisis. OnStar will help, regardless of the individual’s discharge status or enrollment in VA care. Here’s
more information on how OCE
builds effective partnerships to support Veterans. Postvention
— VA offers support after suicide loss: Helping
survivors work through emotions Compared with many other kinds of loss, suicide can be particularly challenging for survivors. Specifically, they must wrestle with the difficult moral, societal and religious implications. Shock at the suddenness of the death may compound their grief. Or they may feel a mix of shame, anger, guilt and, sometimes, relief. Some survivors blame themselves for not noticing warning signs, even though such signs may not have been obvious. And the effects extend beyond close family members. Even first responders, who never personally knew the deceased person, can be affected emotionally by the suicide scene. USPV provides postvention information and resources to assist survivors as they navigate their healing journey, both immediately after the loss and in the months and years that follow. What is postvention, and who benefits from it? Suicide prevention aims to avert incident, while postvention fosters healing afterward, for those touched by the loss. With tens of thousands of suicides every year in the U.S., coping with the aftermath is an unfortunate reality for more people than some might think. For every suicide, an estimated average of 135 people are affected. Beyond the immediate circle of grieving family members and friends, those who regularly interacted with the person who died also can be affected. This includes coworkers, doctors, neighbors, bus drivers or a regular waitress at a favorite restaurant. Quality postvention can facilitate survivors’ healing. It helps them understand and address the complex thoughts and emotions that make coping after a suicide loss particularly challenging. USPV offers a safe space where loss survivors can explore painful and challenging emotions. It strives to create a community of shared healing by improving education about postvention and access to support and resources. VA’s Office of Mental Health and Suicide Prevention supports USPV. However, most USPV resources support anyone who has been touched by suicide loss regardless of their military, Veteran or military family status. At the heart of USPV is a website that features multimedia resources designed to promote open dialogue. The site is structured to meet the needs of community members, health care providers and workplace colleagues. It offers videos, infographics and podcasts related to connecting and healing. How is suicide postvention part of prevention? Experts consider exposure to suicide a risk factor for suicide. Survivors are at greater risk for substance use disorders and mental health issues than those who haven’t experienced such a loss. This includes including thoughts of suicide. Those exposed to suicide in the workplace are 3.5 times more likely than others to take their own lives. In a military unit with five or more suicide attempts in a year, the risk for another attempt is double that of units that had no attempts. Grief after loss can be so intense that it prevents survivors from seeking help at a critical crossroad. But by helping survivors heal after a suicide, postvention reduces the risk of additional suicides in the deceased person’s circle. In that way, postvention healing is a vital component of prevention. Postvention is so important that the Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) has established USPV as part of VA’s mission to develop, disseminate and implement a comprehensive prevention program. To learn more about USPV at the Rocky Mountain MIRECC, visit www.mirecc.va.gov/visn19/postvention/. Resources If you know someone grieving after a suicide loss, you may wish to read about ways you can help and talk to them. To learn about mental health support for Veterans, visit mentalhealth.va.gov. If you or someone you know is in crisis, don’t hesitate to get help.Call 9-1-1 immediately. Source: www.blogs.va.gov/VAntage/78063/postvention-va-offers-support-suicide-loss/ Can
an Algorithm Prevent Suicide? 11/23/20 At a recent visit to the Veterans Affairs clinic in the Bronx, Barry, a decorated Vietnam veteran, learned that he belonged to a very exclusive club. According to a new A.I.-assisted algorithm, he was one of several hundred V.A. patients nationwide, of six million total, deemed at imminent risk of suicide. The news did not take him entirely off guard. Barry, 69, who was badly wounded in the 1968 Tet offensive, had already made two previous attempts on his life. “I don’t like this idea of a list, to tell you the truth — a computer telling me something like this,” Barry, a retired postal worker, said in a phone interview. He asked that his surname be omitted for privacy. “But I thought about it,” Barry said. “I decided, you know, OK — if it’s going to get me more support that I need, then I’m OK with it.” For more than a decade, health officials have watched in vain as suicide rates climbed steadily — by 30 percent nationally since 2000 — and rates in the V.A. system have been higher than in the general population. The trends have defied easy explanation and driven investment in blind analysis: machine learning, or A.I.-assisted algorithms that search medical and other records for patterns historically associated with suicides or attempts in large clinical populations. Doctors have traditionally gauged patients’ risks by looking at past mental health diagnoses and incidents of substance abuse, and by drawing on experience and medical instinct. But these evaluations fall well short of predictive, and the artificially intelligent programs explore many more factors, like employment and marital status, physical ailments, prescription history and hospital visits. These algorithms are black boxes: They flag a person as at high risk of suicide, without providing any rationale. But human intelligence isn’t necessarily better at the task. “The fact is, we can’t rely on trained medical experts to identify people who are truly at high risk,” said Dr. Marianne S. Goodman, a psychiatrist at the Veterans Integrated Service Network in the Bronx, and a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai. “We’re no good at it.” Deploying A.I. in this way is not new; researchers have been gathering data on suicides through the National Health Service in Britain since 1996. The U.S. Army, Kaiser Permanente and Massachusetts General Hospital each has separately developed a algorithm intended to predict suicide risk. But the V.A.’s program, called Reach Vet, which identified Barry as at high risk, is the first of the new U.S. systems to be used in daily clinical practice, and it is being watched closely. How these systems perform — whether they save lives and at what cost, socially and financially — will help determine if digital medicine can deliver on its promise. “It is a critical test for these big-data systems,” said Alex John London, the director of the Center for Ethics and Policy at Carnegie Mellon University in Pittsburgh. “If these things have a high rate of false positives, for instance, that marks a lot people at high risk who are not — and the stigma associated with that could be harmful indeed downstream. We need to be sure these risk flags lead to people getting better or more help, not somehow being punished.” The V.A.’s algorithm updates continually, generating a new list of high-risk veterans each month. Some names stay on the list for months, others fall off. When a person is flagged, his or her name shows up on the computer dashboard of the local clinic’s Reach Vet coordinator, who calls to arrange an appointment. The veteran’s doctor explains what the high-risk designation means — it is a warning sign, not a prognosis — and makes sure the person has a suicide safety plan: that any guns and ammunition are stored separately; that photos of loved ones are visible; and that phone numbers of friends, social workers and suicide hotlines are on hand. Doctors who have worked with Reach Vet say that the system produces unexpected results, both in whom it flags and whom it does not. To some of his therapists, Chris, 36, who deployed to Iraq and Afghanistan, looked very much like someone who should be on the radar. He had been a Marine rifleman and saw combat in three of his four tours, taking and returning heavy fire in multiple skirmishes. In 2008, a roadside bomb injured several of his friends but left him unscathed. After the attack he had persistent nightmares about it and received a diagnosis of post-traumatic stress. In 2016, he had a suicidal episode; he asked that his last name be omitted to protect his privacy. “I remember going to the shower,
coming out and grabbing my gun,” he said in an
interview at his home near New York City. “I had a
Glock 9-millimeter. For me, I love guns, they’re like a
safety blanket. Next thing I know, I’m waking up in
cold water, sitting in the tub, the gun is sitting right
there, out of the holster. I blacked out. I mean, I have no
idea what happened. There were no bullets in the gun, it
turned out.” Veteran
Suicide Rate Increase & Covid-19 2020 veteran suicide studies and full data are not yet conclusive, as more time, research and compilation of data is needed. Some 2020 and ongoing studies are already suggesting, based on the numbers and correlation available at this time, that the military and veteran population has seen up to a 20% increase in suicides since the coronavirus and lockdown started in March 2020 in the United States. Factors That May Contribute to This Increase During Covid-19: Social Isolation– social isolation is hard on humans. We are naturally wired to need connection and community. Veterans often already feel isolated in many ways, many due to mental and physical disabilities and struggles. The lockdown and overall message to stay away from people during the COVID-19 epidemic has absolutely increased the feeling of isolation, in both veterans and nonveterans alike. Unfortunately, for veterans who are already facing some big mental and physical disability hurdles and struggling with feeling connected, this increased social isolation can be devastating. Rise in Substance Abuse– whether it be alcohol, controlled substances, prescription or illegal drugs, many have turned to substance use and abuse as a way of numbing or coping with the stress, fear and isolation of the past year. Nationwide, usage data and deaths from substances (including overdose) have risen dramatically. The Center for Disease Control and Prevention (CDC) presented data that as of June 2020, over 13% of people started or increased, substance use. This percentage is likely much higher than 13%. Another good article on this topic available here. Financial Impact, Job Changes & Unemployment– for many Americans, veterans included, Covid brought about massive job and livelihood changes. This ranged anywhere from having work hours and pay cuts, to being laid off and losing a primary or important financial resource for themselves and/or their family. Unemployment became even more dire as jobs changed or became more scarce due to businesses cutting back, changing hours and offerings, or totally shutting down temporarily or permanently due to unrecoverable losses. The VA cites a veteran unemployment rate increase from 2.3% in April 2019 to 11.7% in April 2020. Fear and Stress of Getting Sick– this pandemic has brought a new type of fear to our generation. Many now greatly fear for their health and that of their family during this time. This fear is exacerbated by nonstop media coverage, fear mongering, division, and having to deal with a global pandemic that is unprecedented for most in their lifetime. Loss of Someone– losing someone at any time and for any reason is hard. For those who have lost someone to Covid, while also struggling with other circumstances, the impact is likely to be even more detrimental. Childcare Changes and Struggles– Many schools went virtual for most or all of the last 3/4 of 2020. (Some are still virtual in 2021.) Whether you support this or not, the strain this has caused on parents is indisputable. Balancing at home virtual learning for their children, caring for younger, preschool aged children, and still managing their day to day work responsibilities, became a new normal for many households, and dramatically increased stress levels for most. Division of Reports, Opinions, Politics and Media– this has undoubtedly been a year of high division in our country. No matter what your alignment in regards to politics and health, the fact is many conflicting views, expert opinions, and political stands have been pushed HARD during this time. Watching news coverage and reading media reports is already linked to higher anxiety, worry and stress. Add to this the type of coverage and division we’ve experienced and are constantly bombarded with in the media during a global pandemic and an election year, and you end up with a massive piece of stress/anxiety pie. The VA reported that veterans who used VA Health Services in 2020 showed a decreased likelihood for suicidal thoughts or inclinations. This study and statement is misleading, as these numbers come strictly from veterans who are actively utilizing Veterans Health Administrative care, and does not address those who are not actively seeking or receiving care for their mental health struggles or disabilities. Of the number of veterans who die each day from suicide, Col. Michael Hudson, VP of veterans behavioral health data collection service ClearForce, estimates that 70% were not in contact with the VA. The VA’s Public Model for Suicide Prevention shows that starting with awareness, local intervention, and clinical strategies, the hope is that more veterans will engage, access health care, and the suicide rates will decrease. This may be a step in the right direction, but such a prevalent issue needs much more attention, awareness, and connection. It is so important to REACH OUT immediately if you, or someone you know, is struggling. Call the Veteran and Military Crisis
Line at 1-800-273-8255 and PRESS 1.or text 838255 What is
988? Signed into law in 2020, the National Suicide Hotline Designation Act authorized 988 as the new three-digit number for the National Suicide Prevention Lifeline. All telephone service providers in the U.S. must activate the number no later than July 2022; however, many providers will choose to implement the service sooner. Once a Veteran's telephone service provider makes 988 available, Veterans can use this new option by dialing 988 then pressing 1 to contact the Veterans Crisis Line. Veterans may still reach the Veterans Crisis Line with the current phone number—1-800-273-8255 and Press 1— through chat, and by text (838255). Frequently Asked Questions The 988 expansion directly addresses the need for ease of access and clarity in times of crisis, both for Veterans and non-Veterans. How It Works Your call to the Veterans Crisis Line is free and confidential, and you decide how much information to share. Support doesn't end with your conversation. Our responders can connect you with the resources you need. Source: www.veteranscrisisline.net/about/what-is-988/
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