The Department of Defense (DOD) and the Department of Veterans Affairs (VA) in recent months have delivered grim statistics on military and veteran suicides. In a report earlier this year, the VA announced veterans committed suicide at a rate of 22 per day in 2010. Active-duty military suicides reached a record high in 2012, at 349. The Army had the most suicides, at 182, though 52 cases are still under investigation.
The DOD and the VA have a number of initiatives to address the issue, including the Strong Bonds and Ask Care Escort programs, and the National Suicide Prevention Lifeline. The VA, meanwhile, attempts to track veteran suicides, identify risk factors, and provide intervention services to prevent veterans from taking their own lives.
To track suicides, the Veterans Health Administration (VHA) combines its enrollment data with information from two databases at the Centers for Disease Control and Prevention (CDC): the National Death Index (NDI), and the National Violent Death Reporting System (NVDRS). The VHA then uses the data to identify risk factors for suicide, such as mental illness and a lack of access to providers who can treat physical, mental health, or substance abuse issues.
Seven VHA Suicide Prevention Interventions for Veterans:
The VHA’s suicide prevention efforts fall into seven categories:
1) Easy Access to Care
The VA 2013 budget estimates that only 39 percent of America’s 22.2 million veterans sign up for VHA care. One in 10 non-elderly veterans neither uses VHA benefits nor is covered under a private health plan. To increase access to care, the VHA has expanded its mental health care services, in part using telehealth. It has also required VHA providers to give new patients seeking mental health services an initial assessment within 24 hours.
Many veterans feel uneasy about getting mental health care, so the VHA has launched a few mental health education and training programs and guides targeting VHA staff, veterans and their families, their communities, and health care providers.
3) Screening and Treatment
The VHA screens veterans for a variety conditions that increase the risk of suicide, such as depression, post-traumatic stress disorder (PTSD), and traumatic brain injury (TBI). Veterans who test positive for those conditions get follow-up visits and treatment.
4) Limited Access to Lethal Means
The most common means for suicide are firearms, suffocation, and poisoning. To mitigate access to those means, the VHA has a gun safety program and a demonstration project to promote drug safety.
5) Suicide Hotline
The Substance Abuse and Mental Health Services Administration (SAHMSA), in the U.S. Department of Health and Human Services (HHS), operates the National Suicide Prevention Lifeline. But the VHA and SAHMSA team up to manage a separate hotline dedicated to veterans, called the Veterans Crisis Line. Of the 500,000 calls the crisis line has received since 2007, 73,000 have been referred to suicide prevention coordinators.
6) Media Restrictions
With the idea that one suicide might provoke other suicides, the VHA monitors news coverage of veteran suicides and encourages media to cover them in a way that is “ethical and responsible.”
7) Suicide Prevention Coordinators
Every VA medical center has a suicide prevention coordinator who keeps track of veterans at high risk for suicides. The coordinators work with physicians and other clinicians to come up with patient safety plans, which describe how a veteran should manage crises that might lead to suicide.
More Information on Military Health Care:
The U.S. Military Health System is a massive network of hospitals, clinics, and other providers who care for almost 10 million active-duty military service men and women. TRICARE is the health plan for military dependents and retirees. See my previous posts on the Military Health System and TRICARE, and the high number of uninsured veterans under 65. Also see this detailed Congressional Research Service (CRS) report for more information on the VHA’s suicide prevention efforts.