WASHINGTON – Three veterans killed themselves last week on Department of Veterans Affairs health care properties, barely a month after President Donald Trump announced an aggressive task force to address the unremitting problem of veteran suicide.
Trump’s executive order was a tacit acknowledgment of what the deaths rendered obvious: The VA has not made a dent in stemming the approximately 20 suicide deaths every day among veterans, about 1½ times more often than those who have not served in the military, according to the most recent VA statistics available.
A 2015 measure that required officials to provide annual reviews of mental health care and suicide prevention programs has found that veterans often receive good mental health care at many VA centers — but that has not decreased suicide rates. A relatively new program, known as the Mayor’s Challenge, that helps city and state governments reach more veterans through more public health programs via VA partnerships has shown some promise, but no data exist yet to show a reduction in suicides.
While the VA has been the public face of the issue, veterans are in many ways an amplification of the same factors that drive suicide in the broader U.S. population: a fragmented health care system, a shortage of mental health resources, especially in rural areas, a lack of funding for suicide research and easy access to guns. All of these contribute to the drastically increased suicide rate among all Americans, which rose 33% from 1999 to 2017.
High rates of homelessness, traumatic brain injuries, post-traumatic stress and a military culture that can be resistant to seeking help are all aggravating factors for veterans, whose rates of suicide have been the subject of numerous hearings on Capitol Hill.
“We are not even at the Sputnik stage of understanding problems with mental health,” said Robert Wilkie, secretary of Veterans Affairs. “I have said this is the Number 1 clinical priority that is made manifest by the president putting VA as the lead for this national task force.”
Some programs to address veteran suicide are showing promise.
A study of nine VA emergency rooms found 45% fewer suicidal behaviors among patients who received follow-up outreach after suicide attempts; as a result of this study, all VA medical centers have put into place the Safety Planning Intervention program.
Since the VA in 2017 began tracking suicides at its facilities — among the most high-profile of veteran suicides — there have been more than 260 suicide attempts, 240 of which have been interrupted, VA officials say.
Yet about 70% of veterans do not regularly use the VA, access to a federal department that may be viewed as central to suicide prevention.
“The vast majority of veterans that die by suicide are not seeking services,” said Julie Cerel, a professor at the University of Kentucky and president of the American Association of Suicidology. “So the VAs are kind of at a loss of how to serve this group of people. Yet when they do end their lives, it becomes the responsibility of the VA,” in the viewpoint of critics, she said.
Leadership turmoil — a consistent trait of the Trump administration — has complicated the VA’s attempt to address suicide. The agency’s director of its prevention office, Caitlin Thompson, resigned in 2017 after tangling with political appointees. According to a Government Accountability Office report last year, the office has essentially languished. Most notably, the office spent $57,000 of its $6.2 million media budget, and its presence on social media declined 77% from the levels of 2015, the report found. Lawmakers expressed outrage.
Although VA officials blamed miscommunication at the time, Keita Franklin, the department’s new executive director of suicide prevention, said that the program had been delayed to come up with a more targeted marketing campaign, called #BeThere. It will try to “talk more specifically with targeted audiences,” she said, noting campaigns focused on 18- to 24-year-olds might focus on texting a friend in trouble while the over-60 crowd would be encouraged to have coffee. Some advertisements would be honed for women, for example, or for veterans in rural communities.
Many suicide experts believe that a lack of proper training in suicide prevention in the broader mental health field, hobbled by a lack of research into a matter that has stymied so many public health officials, is central to the issue.
In 2017, the suicide rate in the U.S. reached 14 per 100,000 people, according to the Centers for Disease Control and Prevention; it is the nation’s 10th leading cause of death. Yet only $68 million is expected to be spent on suicide research this year, according to the National Institutes of Health. In comparison, breast cancer will receive about $709 million in research funding, and $243 million is expected to be spent this year on prostate cancer research.
“There has been tremendous research on breast cancer and AIDS, which lowered mortality rates on diseases” we once thought insurmountable, Cerel said. “However, we have not had comparable research into suicide.”
Guns are used in the majority of veteran suicides, in large part because gun ownership is high for that group. Last year, about 80% of suicides among veterans in Montana were by firearms, said Claire Oakley, director of health promotion at RiverStone Health, a community provider attached to the Mayor’s Challenge in Billings, which has had among the highest rates of suicide in the nation.
“Awareness is important but it does take funding and there is no capacity funding to do this work,” she said.