VA Suicide Prevention Programs
On behalf of Iraq and Afghanistan Veterans of America’s 200,000 member veterans and supporters, thank you for inviting me to speak on one of the most pressing issues facing veterans and their families: the staggeringly high rate of suicide among services members and veterans.
My name is Tom Tarantino and I am the Senior Legislative Associate with IAVA. I proudly served 10 years in the Army, beginning my career as an enlisted Reservist, and leaving service as an Active Duty Cavalry Officer. Throughout these 10 years, my single most important duty was to take care of other soldiers. In the military, they teach us to have each other’s backs, both on and off the field of battle. And although my uniform is now a suit and tie, I am proud to work with this Congress to continue to have the backs of America’s service members and veterans.
Today’s hearing on suicide could not have come at a more critical time. The Army recently reported 30 potential suicides among active duty soldiers and non-activated reservists in October, and 25 potential suicides within the same group in September. These are some of the highest numbers we have seen from the Army since it began releasing suicide data in 2009—and that’s just one branch. The Defense Department recently reported that 468 active duty and reserve soldiers, sailors airmen, and Marines committed suicide in 2010. Overall, the Department of Defense tracked 863 suicide attempts. The rate for veterans is likely much higher.
Although we have this limited data about service members, there remains a fundamental gap when it comes to understanding veteran suicide. The VA does not regularly release data on the number of veterans that commit suicide and there is almost no information about veteran suicide among the forty-seven percent of veterans of Operations Enduring Freedom and Iraqi Freedom who never interact with the VA. We therefore only have blurry snapshots of the problem. For example, the VA estimated that in 2009, 6000 veterans committed suicide. It has also said that on average, 950 suicides are attempted each month by veterans who are receiving some type of VA treatment. That's an average of 31 veterans attempting suicide per day. And again, these tragic numbers only capture the limited segment of veterans who interact with the VA.
One of the greatest challenges in understanding and preventing veteran suicide is this lack of full data. If we don’t know the entirety of the problem, how can we solve it? Even in this age of information and technology, we still have no way of tracking veterans unless they interact with a social service that happens to ask about their military service. This is unacceptable. To address this problem, we must think outside the box. IAVA recommends collecting this data by expanding existing services like the Center for Disease Control and Preventions’ National Violent Death Reporting System. Currently, the CDC collects data on all manner of violent death—including suicide—in 16 states. Veteran status can be reported to the CDC either through the death certificate or by information collected by the medical examiner. By expanding the database to all 50 states, and requiring medical examiners to report veteran status to the CDC, we can get a clearer picture of the problem.
A critical step to understanding how we can stop veteran and service members suicides is to understand that suicide itself is not the whole issue. Suicide is the tragic conclusion of the failure to address the spectrum of challenges returning veterans face. These challenges are not just mental health injuries; they include challenges of finding employment, reintegrating to family and community life, dealing with health care and benefits bureaucracy and many others. Fighting suicide is not just about preventing the act of suicide, it is about providing a “soft and productive landing” for our veterans when they return home.
The conflicts in Iraq and Afghanistan have resulted in a high incidence of mental health injuries among returning service members. According to a RAND study, nearly one third of Iraq and Afghanistan veterans will develop combat-related mental health issues. Many of these cases will go untreated, and if allowed to fester, develop into severe Post Traumatic Stress Disorder.
The problems with Mental Heath Care within the VA system have been well-documented over the past few years. The VA reports that 18 veterans in their care commit suicide every day. Wait times for mental heath care remain unacceptably high, and there are not enough mental heath providers to meet the need.
A recent RAND survey of veterans in New York state revealed that many veterans face difficulty navigating the complex systems of benefits and services available to them. While this survey was specific to New York veterans, the results are indicative of veterans’ experiences nationwide. Veterans reported that they do not know how to find the services they need or apply for the benefits they have earned. Even when they are able to find services appropriate for their needs, many vets report frustration in accessing these services. Some veterans report long waiting periods to get an appointment at the VA, while others with frequent appointments have reported having to repeatedly re-tell their stories and experiences to a number of different providers. These delays and lack of continuity certainly cannot help a veteran already suffering from mental health issues. This survey also revealed difficulty in accessing services is not limited to the VA; most respondents could not identify a state agency or non-profit that provided direct mental health services.
We also know that many veterans may not be seeking care because of the stigma attached to mental health injuries. Multiple studies confirm that veterans are concerned about how seeking care could impact their careers, both in and out of the military. Concerns include the effect on their ability to get security clearances and how co-workers and supervisors would perceive them. It is critical that we continue to work to reduce this stigma.
To combat this, IAVA recommends that the VA and DoD partner with experts in the private and nonprofit sector to develop a robust and aggressive outreach campaign. This campaign should focus on directing veterans to services such as Vet Centers, as well as local community and state based services. It should be integrated into local campaigns such as San Francisco’s veterans 311 campaign. This campaign should be well-funded and reflect the best practices and expertise of experts in both the mental health and advertising fields. For our part, IAVA has partnered with the Ad Council to launch a public service awareness campaign that is focused on the mental health and invisible injuries facing veterans of Iraq and Afghanistan. Part of this campaign focuses on reducing the stigma of seeking mental health care. We are happy to share our best practices from this campaign to aid in this effort.
Tackling Transition: Providing A Stable Environment For Veterans’ Transition
Providing a smoother transition from the military to the civilian world is crucial in preventing veteran suicide. Ensuring veterans’ access to mental health care is connected to other issues that can contribute to a veterans’ sense of stability throughout their transition home. We must tackle the other contributing factors—such as unemployment and homelessness—that could increase the risk for vets who are vulnerable to suicide.
Finding employment is one of the top challenges facing veterans during their transition from military to civilian life. In 2010, the average unemployment rate for OIF/OEF-era veterans was a staggering 11.5%, almost 2 percentage points higher than the national average. This rate is trending even higher so far this year. This leaves veterans wondering where the next pay check will come from, unable to support their families, and unsure of long-term career prospects. Congress wisely addressed this problem recently by passing the VOW to Hire Heroes Act. While this legislation is a critical piece of the puzzle, we must remain vigilant to ensure that the critical programs in the VOW to Hire Heroes Act are implemented.
Some veterans also struggle to find a permanent home. The VA reported that there were more than 13,000 Iraq and Afghanistan veterans homeless in October 2010. Having a place to call home is a foundation upon which to build one’s life. Without a home, finding employment, maintaining relationships, and receiving mental health care become more difficult. The number of homeless veterans is already too high. We need to act now to end veteran homelessness. There is no excuse.
Addressing the spectrum of challenges facing veterans during their transition home will go a long way to create a sense of stability for veterans that may be vulnerable to suicide. This is a place you can step up to create a network of support for every veteran as they return home. This robust community of support should be the first line of defense against veteran suicide.
Building A Community of Support
A community of support starts with the families of veterans and service members. These families need to be prepared—and supported—to help smooth the transition of their returning service member. In RAND’s study of New York veterans, thirty-five percent of military spouses reported that they struggled to reintegrate the returning service member into day-to-day family life. Families also reported feeling unprepared for the return of the service member; many noted that they did not know what symptoms and behaviors to look for. While there are many resources currently available to assist military families, they are often difficult to navigate and complex to understand. We need to place more emphasis on outreach, education and support for military families so that they in turn can support a returning service member.
The responsibility of support does not lie on our military and veteran families alone. Preventing veteran suicide and easing the transition from military to civilian life is our collective responsibility as a community. Veterans consistently report difficulty relating to their civilian peers. In a particularly poignant example, one RAND respondent stated,
“When I’m faced with civilians who don’t understand what I’ve been through, it’s really difficult to try [to] get on the same level with them without making [myself] feel pathetic.”
His statement tells us two things: (1) we must connect vets to fellow vets that have gone through similar experiences, and (2) we should raise awareness across the civilian community about the experience of these veterans and their families, and the challenges they face reintegrating into the civilian world.
IAVA has been a leader in connecting veterans to their counterparts across the country. One of the signature features of the wars in Iraq and Afghanistan is that less than one percent of Americans have served in either. One of IAVA’s top priorities is to connect veterans in local communities and across the country through traditional events and our exclusive Community of Veterans online community. Through IAVA’s awareness campaign, in partnership with the Ad Council, we push the message to veterans that they are not alone: there is a community of vets that understands their experiences and has their backs.
But our veterans are not just readjusting to their families or connecting with other veterans. They are coming back to their jobs, using their GI Bill to study at local colleges, and seeking care and services from businesses and providers across the country. We also must focus on extending understanding to spouses and society at large. Teachers and professors should know which of their students are veterans, or the children of veterans or service members. Businesses should invest in the leadership of returning veterans by hiring them. Health care providers must understand the injuries facing these incredible men and women. By promoting awareness, we can ensure that our entire community is able to support our veterans throughout their transition back to civilian life and help stem the tide of veteran suicide.
By accurately measuring the problem, improving access to mental health care, tackling the transition from military to civilian life, and creating a robust community of support for our veterans, we may be able to significantly reduce the number of veterans that attempt and commit suicide each year. Veteran suicide does not have a “silver bullet” solution. But better practices are out there. We don’t want to ask ourselves if there was something more we could have done.
Thank you for your time and attention.