Coaxing Veterans Into Treatment to Prevent Suicides

This article was originally published by Stateline, an initiative of The Pew Charitable Trusts.

Editor’s Note: Veterans who are in crisis or having thoughts of suicide, and those who know a veteran in crisis, can call 800-273-8255 and press 1, chat online at VeteransCrisisLine.net/Chat, or text 838255.

CHARLESTON, S.C. — To Army veteran Everett Brockington, 52, there’s no mystery about why so many veterans die by suicide: “They’ve seen things and done things that they can’t handle. And they’ve lost too many of their close friends.”

Most of the veterans Brockington knows rely on one another for support instead of seeking mental health services.

“We talk to each other about our problems all the time,” Brockington said. But he admitted, “It would be better if we had someone to talk to who knew what they were doing.”

Although retired and active military service members die by suicide at twice the rate of civilians, research shows that veterans who receive mental health care are much less likely to end their lives than those who don’t. A soon-to-be-released study from the Medical University of South Carolina here in Charleston may shed light on how to persuade reluctant veterans to seek that professional help.

For veterans, the primary barrier to treatment is the stigma associated with seeking mental health services, which male veterans in particular consider a sign of weakness, said Tracy Stecker, a psychologist at the Medical University of South Carolina’s School of Nursing and the lead researcher in the study.

Fears and myths about suicide prevention also get in the way, she said.

“Veterans are afraid that if they admit they’re thinking about killing themselves, somebody will come snatch them up and put them in a hospital and make them take medicine,” she said.

Stecker’s study, funded by the U.S. Department of Defense, aimed to find out whether a simple phone call could help veterans suffering from suicidal thoughts take that first critical step in seeking treatment.

She and a team of researchers called a thousand veterans who volunteered to participate in the study. They screened them for five mental health symptoms — sleep loss, post-traumatic stress syndrome, depression, substance use, pain and suicidal thoughts or attempts — five times during the year after they initially made contact.

Half of the participants also received a call from a psychologist who discussed with them their fears and concerns about seeking mental health treatment. For any participants who decided they wanted treatment during the study, the researchers connected them directly to a local mental health provider.

Stecker’s study, slated for publication later this summer, found that the veterans who simply talked on the phone to a mental health professional about getting help fared better in terms of suicidal thoughts and other mental health symptoms than those who didn’t, and they were more than twice as likely to seek mental health care during suicidal episodes.

“That was our hypothesis going in,” Stecker said, “so it wasn’t surprising.”

“What was surprising was how easy it was to recruit a thousand veterans from across the country who said they had considered or attempted suicide, hadn’t received mental health services, and were willing to participate in our study.”

VA Success

Nationwide, an average of 20 current and former military service members die by suicide each day. Of those, an average of six were connected to the U.S. Department of Veterans Affairs health system. Only half of all veterans who need mental health services are receiving them, according to the VA.

But even as suicide rates are rising in both the civilian and military populations, the rate of death by suicide among veterans connected to the VA health system is declining.

“The VA has done a good job of focusing on suicide and making sure that those in their health system get quality care,” said Jerry Reed, who heads a suicide prevention research and advocacy group at the Washington, D.C.-based Education Development Center.

“The real challenge is to find the veterans who are not connected to the system. The VA is still trying to crack the code for finding those 14 veterans of the 20 who take their lives every day in the civilian community.”

Charleston, home to the Citadel military academy and combined Air Force and Navy training center Joint Base Charleston, has the seventh-largest metropolitan concentration of military personnel in the country. South Carolina, with a population of roughly 5 million, ranks 11th in the nation for its percentage of military in the adult population.

South Carolina’s suicide rate in 2017 was 16 per 100,000 people, slightly higher than the national average of 14. Its veteran suicide rate is roughly equal to the national average of 30.

In 2018, a total of 815 South Carolina residents died by suicide.

At the Ralph H. Johnson VA Medical Center here in Charleston, where more than 360 mental health practitioners see dozens of veterans every month who are haunted by suicidal thoughts, it’s clear that many factors beyond the battlefield put veterans at risk of ending their lives.

As in the general population, economic pressures, broken relationships, health problems and loneliness are among more than 30 factors that the VA has determined can increase the risk of suicide among retired and active-duty military personnel.

“What’s so shocking is that only 50% of the veterans at high risk for suicide are involved in getting mental health care,” said Dr. Donald Myrick, who heads the hospital’s mental health unit. He and his staff are trying to change that.

About a year ago, Myrick’s group started using a database that incorporated risk factors for his department’s more than 26,000 patients — including age, recent cancer diagnosis, divorce, substance use, homelessness and job loss — to predict who was at greatest risk of suicide.

They found roughly 400 patients at high risk of suicide and started calling them every week to see if they wanted help with depression, anxiety, PTSD or suicidal thoughts.

“We found that 70% were engaging with us,” Myrick said. “They were saying they wanted help, and they followed through.”

In addition, the Charleston-area VA embeds mental health professionals in its primary care clinics outside of the city so that veterans seeking physical health care can see a therapist if their doctor thinks they may need one.

At the hospital in historic downtown Charleston, physicians and psychologists follow up with all discharged mental health patients, completing at least four phone calls with each patient to check on how they’re feeling.

Veterans in Need

Brockington walks with a cane and wears a back brace. “I have so many medical problems, it’s depressing,” he said. But sitting in front of the VA hospital here in late May, surrounded by palmettos and well-maintained gardens, he said he considers himself one of the lucky ones.

A South Carolina native, Brockington said he traveled nearly two hours to get to Charleston on a scorching afternoon last month so he could pick up a new CPAP breathing machine for his sleep apnea problems. He said he’s OK in the mental health department, though his face saddens when he talks about the prevalence of suicide among his fellow veterans.

Sleep loss is a major suicide risk factor, Stecker said, as are chronic health problems. “Most people who are at risk of suicide don’t know it,” she said. “That’s a big part of the problem.”

At the national level, the VA this year launched a multimillion-dollar social media and ad campaign to find veterans who may be at elevated risk of suicide.

That came after a scathing Government Accountability Office report that concluded lack of leadership in the department during the first year of the Trump administration had led to a failure to reach out to and educate veterans about suicide risk and the value of mental health services.

Since then, the VA’s suicide prevention division has spent $12 million on outreach in 2018, including $1.5 million on paid media. This year’s suicide prevention outreach budget is $20 million, according to the VA.

In addition, local suicide prevention coordinators connected to the VA’s 170 medical centers nationwide held more than 20,000 outreach events to contact veterans at risk for suicide, according to the VA. As a result, they are now managing care for nearly 11,000 veterans, according to the agency.

“We’re trying to improve our outreach to veterans where they work, live and thrive in the community,” Dr. Keita Franklin, the VA’s director of suicide prevention, told Stateline in an interview.

“When they’re in active duty, they’re taught a culture of ‘Fight on, push on, pull yourself up by your bootstraps.’ Then when they leave, we tell them they need to ask for help and come in and get mental health care. It’s a tough transition,” she said. “But we know that once they get into care they do better.”

Myrick’s group here in Charleston periodically sets up folding tables —with information on mental health services and a professional to talk to — at local military bases, police and fire departments, armories, churches and universities. In recent years, the events have resulted in hundreds of veterans seeking mental health services, many of them for the first time.

How did Stecker and her team find a thousand veterans willing to participate in their study? They placed ads on Craigslist, Facebook and other online outlets. The ads didn’t mention suicide or mental health; they simply asked: “Are you considering seeking help?”