Veteran Suicides on the Decrease, But Much Still Needs to Be Done

WASHINGTON — The Department of Veterans Affairs (VA) seems to be making some progress in reducing the suicide rate among veterans, but more work still needs to be done, members of Congress and witnesses said at a House hearing Wednesday.

A report released 2 weeks ago by the VA “contained good news — in particular, it showed a 7.2% decrease in veteran suicide in 2019, the most recent year for which we have data,” said Rep. Mike Bost (R-Ill.), the ranking member of the House Veterans’ Affairs Committee, which held the hearing. “That’s unheard-of progress. But as we all know, the last 2 years have brought unheard-of challenges as well. Those challenges include the COVID-19 crisis, and more recently the crisis caused by the Biden administration’s failure with withdrawal from Afghanistan properly … Veterans who served in Afghanistan and even those who served elsewhere, have been under immense stress, watching the tragic events of the last several weeks unfold.”

According to the VA, “compared to the same time period in 2020, from August 13 to September 15, the Veterans Crisis Line experienced a 6% increase in calls, a 32% increase in chat, and a 71% increase in text, those increases are a direct result of the crisis in Afghanistan,” Bost continued. “They paint a stark picture of the pain that many veterans are experiencing at this moment. It is our responsibility as members of this committee to do everything in our power to support those veterans.”

Holistic Approach Urged

Committee chairman Rep. Mark Takano (D-Calif.) also said that more efforts are needed. “We know that a true public health model of prevention is the most comprehensive, holistic approach to suicide prevention,” he said. “Stable housing is suicide prevention, financial security is suicide prevention, food is suicide prevention, access to high quality and effective healthcare — including mental health care — is suicide prevention, education, employment and living wage, are suicide prevention.”

Takano added that his staff is “putting together a legislative package of mental health and suicide prevention bills that we can move with the urgency we all agree is warranted … This new mental health and suicide prevention website package will include provisions to improve how VA trains its community mental health service providers, increase the number of peer specialists in VA medical centers, expand VA’s Lethal Means Safety Training, add more resources for the Veterans’ Crisis Line, and increase the number of vet centers around the country, and ensure that suicide prevention outreach and care reaches traditionally underserved veteran communities.”

Data collection is a big part of the problem, according to Rajeev Ramchand, PhD, a senior behavioral scientist at the RAND Corporation and co-director of the RAND Epstein Family Veterans Policy Research Institute. He listed four ways it could be improved: “Improve the national mortality data infrastructure; use data to better understand veterans’ healthcare experiences outside of the VA; collect better and more comprehensive data on veteran firearm ownership and storage; and incentivize researchers to collect data on suicide and the testing of novel and promising mental health treatments.”

Timely Access to Mental Health Care at Issue

Ramchand noted that more than two-thirds of veterans who die by suicide do so using firearms. “Many suicidal crises are of short duration, and experts argue that placing time and space between a person in crisis and his firearm — by storing it unloaded and locked — can be life-saving. Many suicide prevention strategies are focused on encouraging such storage practices, but without timely data on how veterans are storing their guns, it will be impossible to know whether these efforts are effective.”

Witnesses disagreed on how quickly veterans were getting access to mental health services. “We now are able to offer same-day access to mental health care, as well as primary care, at every local VA facility,” said Matthew Miller, PhD, MPH, executive director of the Suicide Prevention Program at the VA. Veterans who need mental health care should “get on the phone and call their local facility and say, ‘I’m interested in same-day access for mental health at this facility. Tell me what I need to do, where I need to go, and how we need to kick that in.’ And they should have an SOP and answer for that and if they don’t, we want to be the first to know.”

But Nick Armendariz, a veteran and mobility program manager for the Independence Fund, a veteran service organization, said that his organization “assists numerous veterans who either cannot get access to VA mental health care or do not trust it — more than 25% of the veterans we assist for mental health care refused our referral to the VA, because of mistrust or because of poor prior experience or medication management mishaps in the past.”

“We have veterans who are told by VA schedulers they cannot be seen for 7, 8, or 10 weeks, and when those veterans ask for community care instead, they are told either they shouldn’t go to the community because it’s not as good or because the VA staff don’t believe that they’ll be able to get community care appointments for that veteran.”

More Treatments Urged

Committee members also had ideas about treatments that should be explored. Rep. Greg Murphy, MD (R-N.C.), a urologic surgeon, touted the benefits of hyperbaric oxygen therapy, or HbO2. “As a physician, I found that HbO2 has been successful in treating many veterans, where no other source of treatment was rendering good results,” Murphy said.

“HbO2 is conducted by pacing a patient in a pressurized chamber while breathing pure oxygen. By delivering pure oxygen under pressure, their blood levels for oxygen effectively deliver greater levels to help heal vital organs, including the brain,” said Murphy. “Peer-reviewed, double-blind studies have confirmed the effectiveness of HbO2 for treating PTSD [post-traumatic stress disorder] and TBI [traumatic brain injury]. The majority of combat veterans who have used this therapy have helped restore their executive function and feeling of well- being.”

But Lisa Brenner, PhD, director of the Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention, disagreed. “The findings so far have been mixed for HbO2, though I know VA is still working diligently to try to explore different ways that may be used as part of a whole toolbox of interventions for veterans,” she said.