How Can Government Battle a ‘Suicide Epidemic’ Among Veterans?

The VA has boosted its funding, but Congress’s latest attempt lacks a pay-for.

VIRGINIA BEACH, VA - AUGUST 08: An American flag flies at half staff in front of a Veteran of Foreign War (VFW) Post 392, to honor the fallen Navy SEALs who were based and trained close by at the Naval Amphibious Base Little Creek, on August 8, 2011 in Virginia Beach, Virginia. A U.S. military Chinook helicopter was shot down on Aug. 6, 2011, in Afghanistan, killing 30 Americans, most of them belonging to the same elite Navy SEALs team that killed Osama bin Laden. In addition seven Afghanistan troops were killed making it one of the deadliest incidents of this war. (Photo by Mark Wilson/Getty Images
National Journal
Jordain Carney
April 3, 2014, 7:56 a.m.

The Fort Hood shoot­ing is an ex­treme and shock­ing ex­ample of what has be­come a chron­ic con­cern for the mil­it­ary: sol­diers with men­tal-health prob­lems tak­ing their own lives.

And it’s not just the act­ive-duty mil­it­ary who face what has be­come an in­creas­ingly daunt­ing prob­lem.

At least 22 vet­er­ans com­mit sui­cide each day, ac­cord­ing to the Vet­er­ans Af­fairs De­part­ment. This adds up to more than 2,000 vet­er­ans killing them­selves so far this year alone, and the mil­it­ary com­munity is fa­cing what ad­voc­ates refer to as a sui­cide epi­dem­ic.

To help ad­dress the grow­ing prob­lem, Demo­crat­ic Sen. John Walsh of Montana in­tro­duced le­gis­la­tion last week that in­cludes pro­vi­sions to force the Pentagon to reex­am­ine troops who were dis­charged for PTSD-re­lated be­ha­vi­ors — which can in­clude night­mares, flash­backs, changes in per­son­al­ity, sleep­ing dis­orders, and sui­cid­al thoughts.

The bill also ex­pands vet­er­ans’ eli­gib­il­ity to en­roll in VA health care from five to 15 years after leav­ing the mil­it­ary. The cur­rent sys­tem doesn’t take in­to ac­count the fact that some vet­er­ans have a delayed re­ac­tion to trauma after they leave the ser­vice, ac­cord­ing to vet­er­ans’ ad­voc­ates.

Walsh, who is one of the first Ir­aq War com­bat vet­er­ans to serve in the Sen­ate, is also a mem­ber of the Ir­aq and Afgh­anistan Vet­er­ans of Amer­ica, which backs the bill. Fifty-one per­cent of Ir­aq or Afgh­anistan War vet­er­ans know someone who has at­temp­ted or com­mit­ted sui­cide, ac­cord­ing to a Wash­ing­ton Post/Kais­er Fam­ily Found­a­tion sur­vey re­leased this week.

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“Red tape and gov­ern­ment dys­func­tion have blocked ac­cess to the care that saves lives,” Walsh said in a state­ment.

But a key hurdle re­mains for Walsh’s le­gis­la­tion: how to pay for it.

A cost es­tim­ate has yet to be re­leased from the Con­gres­sion­al Budget Of­fice, but when asked about how Walsh planned to pay for the le­gis­la­tion, his spokes­man said that Walsh has de­scribed the bill as part of “the cost of war.”

But this ap­proach is sim­il­ar to the “paid in full” slo­gan Sen­ate Demo­crats at­tached to a failed pro­pos­al earli­er this year from Sen. Mark Pry­or to re­verse roughly $6 bil­lion in cuts to vet­er­ans’ pen­sions. And in Con­gress’s fisc­ally con­scious at­mo­sphere, Re­pub­lic­ans de­man­ded that fund­ing be off­set by something.

Walsh is, however, open to adding a pay-for to his le­gis­la­tion.

A stalled om­ni­bus vet­er­ans bill by Sen. Bernie Sanders of Ver­mont also has men­tal-health pro­vi­sions, in­clud­ing ex­tend­ing com­bat eli­gib­il­ity and fo­cus­ing on edu­ca­tion and train­ing for men­tal health pro­fes­sion­als.

But sen­at­ors blocked Sanders’s le­gis­la­tion in Feb­ru­ary, with Sen­ate and House Re­pub­lic­ans alike cri­ti­ciz­ing the use of war fund­ing to pay for the vet­er­ans bill.

Walsh’s le­gis­la­tion is the first part of a three-step, year­long out­reach pro­gram be­gun last week by IAVA to raise aware­ness about the sui­cide crisis.

IAVA Pres­id­ent Paul Rieck­hoff hopes Pres­id­ent Obama will is­sue an ex­ec­ut­ive or­der be­fore Me­mori­al Day man­dat­ing that the Pentagon and the Vet­er­ans Af­fairs De­part­ment in­teg­rate elec­tron­ic health re­cords. He also hopes the pres­id­ent will cre­ate a stand­ard­ized meth­od for track­ing sui­cides and sui­cide at­tempts among vet­er­ans and mil­it­ary fam­ily mem­bers.

Na­tion­al track­ing of vet­er­ans sui­cide rates is un­re­li­able at best. Even the VA — whose 22-per-day es­tim­ate has be­come the go-to stand­ard — had to build its na­tion­wide stat­ist­ic with in­form­a­tion avail­able from only 21 states.

The vet­er­ans ad­vocacy group will also spend the year reach­ing out to com­munit­ies across the coun­try to help raise aware­ness.

VA Sec­ret­ary Eric Shin­seki told mem­bers of the Sen­ate that the de­part­ment is broad­en­ing how it tries to reach vet­er­ans, such as by ex­pand­ing “tele­ment­al health cap­ab­il­it­ies,” in­clud­ing a 24/7 crisis line — which the VA says has saved more than 35,000 lives. The crisis line is also avail­able via text mes­sage. VA staffers re­spond to vet­er­ans who text on a range of is­sues in­clud­ing chron­ic pain, an­ger, and de­pres­sion.

“It’s get­ting the vet­er­ans who reach out where they are, in whatever me­di­um is com­fort­able to them,” said Caitlin Thompson, the VA’s deputy dir­ect­or of sui­cide pre­ven­tion.

The De­part­ment of Vet­er­ans Af­fairs re­ques­ted a slight in­crease in its men­tal-health fund­ing in the 2015 budget re­quest — up to $7 bil­lion from $6.9 bil­lion in fisc­al 2014. The VA ex­pan­ded its men­tal-health fund­ing by 64 per­cent between 2009 and 2014. It’s also in­creased its men­tal-health force by 2,400 people since 2012.

Thompson ad­ded that the VA has found that vet­er­ans who aren’t in VA care are more likely to com­mit sui­cide than those who aren’t. Of the 22 vet­er­ans who com­mit sui­cide a day, the VA es­tim­ates that only one in five of them are in VA health care.

Zach McIl­wain, who served two com­bat tours with the Army in Ir­aq, is a part of that out­reach. McIl­wain, like many vet­er­ans, re­turned to the United States suf­fer­ing from posttrau­mat­ic stress dis­order.

“Ba­sic­ally I found my­self where I was slowly sink­ing in quick­sand,” McIl­wain said, cred­it­ing his wife with ur­ging him to get the help that saved him.

McIl­wain also poin­ted out that com­munit­ies can do much more to help vet­er­ans ad­apt to ci­vil­ian life.

“It’s not just Con­gress, it’s not just the pres­id­ent — it’s back in the loc­al com­munit­ies, wel­com­ing these ser­vice mem­ber back home.”

At­tempt­ing sui­cide is cur­rently con­sidered a crime un­der the mil­it­ary’s rules, and something IAVA is hop­ing to get changed.

“A big piece of this is re­mov­ing stigma ,” McIl­wain said. “There’s con­cerns about, ‘Is this go­ing to af­fect my em­ploy­ment; is this go­ing to af­fect my se­cur­ity clear­ance when I’m in the mil­it­ary?’ “

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