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Analysis

VA Grapples With Issue of Veteran Suicide

By MedPage Today  
   May 02, 2019

'Not all of this is about mental health,' said top VA official.

This article was first published on Wednesday, May 1, 2019 in MedPage Today.

By Shannon Firth, Washington Correspondent, MedPage Today.

WASHINGTON -- Members of the House Committee on Veterans' Affairs wrestled with the challenge of veteran suicide during a hearing earlier this week.

Suicides in younger veterans have spiked over the last 2 years, and in the past 6 weeks alone, six veterans took their lives on VA campuses, said Richard Stone, MD, executive in charge of the Veterans Health Administration for the Department of Veterans Affairs.

Each day about 20 veterans die by suicide -- roughly 7,300 deaths per year.

As both the Committee's chair and ranking member noted, those figures have changed little since the 1990s, despite new legislation and increased funding.

In 2015, Congress passed the Clay Hunt Suicide Prevention for American Veterans (SAV) Act, but the bill hasn't done enough to address the problem, said Chairman Mark Takano (D-Calif.).

Ranking member Phil Roe, MD (R-Tenn.), explained that funding for VA mental healthcare rose 258% since 2005 -- now up to $9.4 billion in the most recent budget request -- yet "too little progress has been made."

Stone stressed that "not all of this is about mental health," and agreed that funding is not the issue. Veterans are coping with financial and "relational" issues as well as the challenge of homelessness.

"This is a problem with the society that we live in," he said, highlighting issues of isolation and loneliness.

"I can hire another 24,000 mental health providers, " he said. "I can hire additional people for at-risk [programs], but this is about ... whole health and identifying what connects us as humans to other humans."

Stone pointed out that when his own family moved to a military base, other families visited for weeks, bringing over food and introducing themselves. Now as a civilian, his family knows only the neighbors on either side of their house.

Committee members tried to attack the problem of suicide by zeroing in on specific risk factors, from veterans' access to guns, to homelessness and loneliness.

Rep. Kathleen Rice (D-N.Y.) noted that 69% of veterans complete suicide with a firearm and that female veterans are more likely to use guns than women without a military background.

Richard McKeon, PhD, MPH, chief suicide prevention branch at the Substance Abuse and Mental Health Services Administration (SAMHSA) and Keita Franklin, PhD, national director of suicide prevention for the VA, emphasized the importance of lethal means counseling.

Franklin said teaching clinicians to talk to veterans in a "firearm-friendly way" is a critical part of the safety plan for any at-risk individual.

Rep. Anthony Brindisi (D-N.Y.) pointed to an unusual approach being scaled in upstate New York known as "freeze the keys," where veterans are encouraged to literally place the keys to their gun cabinet in a cup, perhaps one with a photo of a loved one pasted to it, fill it with water, and then freeze it.

Stone said research among survivors has shown that the time between the decision to commit an act of self-harm and actually executing that act can be less than 60 minutes.

In that sense, anything that puts distance between veterans and executing their plan for suicide has value, he said.

Rep. Mike Levin (D- Calif.) highlighted "extreme risk" laws that have been passed in 15 states. Such laws allow a family member or law enforcement to ask a judge to enact temporary restrictions on access to firearms of an individual who shows warning signs of being at risk to themselves or others.

After Connecticut "stepped up enforcement" of its extreme risk law, the state saw a 14% reduction in firearm suicide. Ten years after Indiana enacted a similar law, the state witnessed a 7.5% reduction in its own firearm suicide rates.

Levin asked witnesses if they would recommend Congress pass an extreme risk law to help address the current suicide crisis.

Data from Indiana and Connecticut are "encouraging," he said, but added that he could not take a stance regarding national legislation.

Responding to the issues of isolation and loneliness, Stone noted that organized sports has been one effective intervention for establishing a sense of connection. Research has shown that 150 minutes of organized exercise can have a really "demonstrable protective effect among veterans."

When asked about specific pilot programs that have proven to be effective in reducing suicides, Franklin highlighted "caring outreach" measures, which involves phone calls to individuals who leave the emergency room after a suicide attempt.

The measure was piloted in about seven facilities, Franklin said, and because of its success has been fast-tracked for "full implementation" across all VA emergency departments.

The National Institutes of Mental Health reported a 30% reduction in future suicide attempts with the program and the VA reported a 50% reduction in subsequent attempts.

VA witnesses stressed the agency's "whole health" approach to healthcare, which Stone's written testimony notes includes providing veterans with "proactive, complementary and integrative health approaches," such as stress-reduction, yoga, nutrition acupuncture, and health coaching.

With regard to homelessness, Stone noted that suicide rates spike dramatically at the point of "impending homelessness." Previous research has reported that homelessness and attempted suicide often go hand in hand.

The VA currently has 444 suicide prevention coordinators and is planning to add another 246, Franklin said. One aspect of their work is "in-person outreach engagement" which involves connecting to vulnerable veterans in the community including those in shelters.

“This is about ... whole health and identifying what connects us as humans to other humans.”

Photo credit: Jonathan Weiss / Shutterstock


KEY TAKEAWAYS

Each day about 20 veterans die by suicide -- roughly 7,300 deaths per year.

VA mental healthcare spending rose 258% since 2005 -- now up to $9.4 billion in the most recent budget request -- but little progress has been made.

A 'caring outreach' program has been effective in reducing suicides, and involves phone calls to veterans who leave the ED after a suicide attempt.

The measure was piloted in seven VA hospitals and has been fast-tracked for 'full implementation' across all VA EDs.


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