Veteran suicide: growing numbers, intensified outreach

By Hugh Lessig

Source: Daily Press
Published: Monday 17 June, 2013

HAMPTON —

— Sleep was dangerous for me. I couldn't handle the nightmares. I thought I was psychotic. I diagnosed myself with anything other than PTSD.

I came up with a plan to end the pain, end the nightmares and keep the people I loved from being hurt. I grabbed my pistol, inserted a fully loaded magazine, chambered a round and put the gun to my head. As I was about to end my life, my wife walked into the room . . .

This comes from a narrative written by a young Marine who entered the Hampton VA Medical Center seeking help for post-traumatic stress disorder. He had spent seven months at a tiny firebase in Afghanistan where daily attacks were the norm. He came close to getting killed and killed others to stay alive. Within a month of coming home, he retreated into isolation and alcohol. He couldn't handle the nightmares and began sleeping apart from his wife.

His life was going downhill, and statistics show he was far from alone.

PERSISTENT PROBLEM

Suicides among active-duty U.S. service members have been a concern for years. In 2012, a record 349 American troops killed themselves, more than were lost fighting the enemy in Afghanistan.

In February, the U.S. government issued its most extensive study on veteran suicides, and it showed a higher rate than previously estimated. Covering 1999 to 2012, it showed a rate of 22 deaths a day, or about one every 65 minutes. That compared with a less precise estimate in 2007 that showed about 18 deaths per day.

The veterans study has its limitations. It is based on information provided by 21 states – Virginia provided partial information -- and does not fully reflect the American population at large. Still, it was considered statistically significant for purposes of analysis.

Although veteran suicides had risen in raw numbers, the study also showed the percentage of all U.S. suicides identified as "veteran" declined from 1999 to 2003 and remained relatively constant in subsequent years. Officials at the Department of Affairs said that indicated some progress.

But as more veterans pour into the system, the VA has pledged to expand the war on mental illness, adding staff and working harder to publicize its services, including a veterans crisis line that has seen a steady increase in calls since being establishment in 2009.

"Outreach remains critically important," said VA Under Secretary for Health Robert A. Petzel.

The national trend is evident at the Hampton VA Medical Center, where more veterans from the post-911 generation are coming through the door, some like that Marine, who need immediate help.

BY THE NUMBERS

The patient population at Hampton grew by 7.8 percent in fiscal year 2012, said spokesman James Coty. At present, more than 40,000 veterans in southeastern Virginia and northeastern North Carolina rely on the center as their primary health care provider.

Younger veterans are a growth area. The center has a free standing clinic dedicated to former service members who fought in Iraq and Afghanistan, formally known as the OEF/OIF/OND Clinic, the acronyms of those missions which have defined the 10-year war on terror.

In fiscal year 2012, the clinic treated 6,935 patients. During the first half of this fiscal year – from October through April – it has already seen 5,501 patients.

The staff is surging to keep pace.

The medical center is actively recruiting mental health staff, projecting to go from 250 to 316. tHat includes psychiatrists, psychologists, social workers, counselors and other specialists, plus the administrative staff to support them. Part of the increase was prompted by the VA's nationwide push to hire more than 1,600 mental health professionals across its system. In addition, Hampton had already started specific recruitment efforts, said Dr. Priscilla Hankins, chief of mental health services at Hampton.

Once in the system, mental health treatment will vary.

"It really depends on the individual and what they are willing to commit to," Hankins said.

One effective method is exposure therapy, where patients confront their traumatic experiences. But not everyone goes for it.

"That is a very intensive sort of treatment, but it is one that really does have a good outcome – if you can get someone to commit," she said.

If an initial assessment turns up positive for problems like post traumatic stress disorder or depression, it triggers a second screening for suicide risk. If that's positive, the VA decides on the appropriate level of treatment, whether it be hospital care or regular visits with a counselor.

One thing is clear: Without treatment, a person's life can spiral out of control.

FEELING ALONE

When my wife filed for divorce, I felt alone, hopeless. I spiraled farther into a dark abyss of hopelessness and fear. The nightmares and flashbacks were still haunting me. I never felt at ease, never felt safe. The homicidal and suicidal ideations flooded back, forcing me back to the bottle to help dampen the memories.

I found a girlfriend, but she had no idea what she was about to go through. After an extremely emotional week, I decided that I needed to be hospitalized. I went about it the wrong way, though. I grabbed one of my field knives and cut my arm open twice. I spent the next five days in a psyche ward.

This young Marine avoided becoming a study statistic thanks to the type of intensive treatment Hankins described. After reporting to the Domiciliary PTSD program at Hampton, he began reliving his old experiences through writing. Call it the healing power of the narrative..

I have had to confront demons that I've worked hard at denying since 2010. I am forever grateful to the program that helped save my life.

FOLLOW-UPS A CHALLENGE

Can this man declare victory? Certainly for the moment, but experts say follow up care is important for veterans who have experienced suicidal tendencies.

In March, a VA Inspector General's report faulted the Hampton VA for not meeting follow-up care requirements for patients at risk of suicide. Four of 10 patients considered a high risk of suicide did not receive follow-ups at the required interval of four in the first month. Five of 20 patients considered a lower risk also required more follow-up contacts than the hospital provided.

The review covered facility operations for fiscal 2011 and part of 2012.

Hankins said the center responded by strengthening processes already in place. One challenge, she said, is re-establishing contact with mental health patients once they've left the system.

A separate Inspector General's report in April found same problem on a wider scale. A review of 24 programs of various sizes at VA medical centers found that staff failed to check up on nearly one-third of veterans at risk for suicide.

Responding to the report, the VA said it would create a registry for follow-up on patients discharged from mental health units. It also now requires the VA to make three attempts to contact a veteran who has missed an appointment and document these attempts in the patient's record.

In concluding his healing narrative, that young Marine who left the Hampton VA seemed to realize his battle is ongoing.

I now have the will to live and, more importantly, hope for the future. While I know I will always live with some symptoms, I am now much better equipped to deal with what's in store for me. I am anxious to keep living life and see what the next chapter in my life has to bring.

Reuters contributed to this story.

Need help?

The Veterans Crisis Line connects veterans – and their families and friends – with qualified staff from the Department of Veterans Affairs via a confidential toll-free hotline. Call 1-800-273-8255 and press 1 or send a text message to 838255 to receive confidential support any time, 24 hours a day, 365 days a year.

Go to http://www.veteranscrisisline.net for more information, or to receive help through online chat

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