Government officials and veteran advocates shared new approaches for preventing veteran suicide and expanding access to mental health services during a hearing of the Senate Committee on Veterans’ Affairs on Wednesday.
The committee also explored ways to reduce the mental health stigma that can prevent vulnerable veterans from seeking help.
Around 18 veterans die by suicide each day in the U.S., according to data from the Department of Veterans Affairs, and two-thirds of those veterans have “no meaningful contact” with the VA prior to their deaths, noted the committee’s ranking member, Jerry Moran (R-Kan.).
The pandemic has increased anxiety, depression, and overdose deaths across the country, Moran noted, highlighting a study from JAMA Psychiatry that showed emergency department visits for overdose and suicide attempts spiked in 2020, compared with the same period in 2019.
“For many veterans who already live with mental health conditions or addiction, the added social isolation and the fear due to this pandemic has heightened these conditions,” Moran said.
Erase Stigma, Target Messages
When asked how to reduce stigma around mental healthcare and encourage more help-seeking behavior, Lt. Col. James Lorraine, USAF (retired), CEO of America’s Warrior Partnership in Augusta, Georgia, urged members to “take suicide out of the ‘mental health bucket.'”
“To keep looking at … suicide prevention as solely a mental health solution is somewhat alienating,” he said, reminding senators of the confluence of pressures on veterans from housing and relationship problems to financial and employment issues.
What would help veterans, he added, is to look at the issue more holistically and ask “how do we increase the hope of veterans, overall?”
Thomas Porter, executive vice president for government affairs for Iraq and Afghanistan Veterans of America, argued the need to “over-communicate” specific resources.
As an example, he highlighted his group’s own “Quick Reaction Force,” which provides mental health resources to any veteran, regardless of discharge status, and their family members for free.
To Lorraine’s point, the Quick Reaction Force also provides emergency financial support to veterans in danger of homelessness, he said, which is a risk for about one in four veterans.
Expanding Healthcare Access
Much of the hearing involved senators quizzing witnesses about the “life-saving” provisions of the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, named after a Navy SEAL who died by suicide in 2018, and signed into law in October 2020.
The “Hannon Act” calls for improving access to mental healthcare by strengthening telehealth and alternative therapies, expanding care in the community, researching evidence-based mental health treatments, and holding the VA accountable for how suicide prevention therapies resources are used, said committee chair Jon Tester (D-Mont.).
The bill also includes millions of dollars in scholarship funding to increase the number of mental health professionals in veterans centers, as well as funding to expand the Safety Planning in Emergency Departments (SPED) program.
SPED is an evidence-based intervention that involves clinicians and other ED staff helping to create a safety plan for veterans at risk of self-harm or suicide. After a veteran is considered to be safe enough to be discharged, staff follow up and help connect veterans to outpatient mental healthcare.
The program has been shown to reduce suicide by more than 40% in the 6 months following a hospital visit, Moran said.
Witnesses on Wednesday noted that to date, 100% of veteran facilities have implemented the SPED program.
In addition, Tammy Barlet, MPH, associate director for the National Legislative Service for the Veterans of Foreign Wars (VFW), highlighted a new means of increasing access to care for rural veterans known as “ATLAS pods” (Advancing Telehealth Through Local Access Stations).
The pods are equipped with the necessary technology for veterans to engage in telehealth visits from participating Walmart, American Legion, and VFW locations. Each is staffed by an assistant to help veterans trouble-shoot their appointments, Barlet said.
The first VFW ATLAS site was launched in Eureka, Montana — 60 miles from the nearest veterans clinic — a second pod opened in Pennsylvania, two more are expected in Texas and California next month, and there is interest in opening another 22 locations, Barlet said.
The sites can be used for tele-mental health as well as other medical visits, and funding from the Hannon Act could help scale the model, she said.
Mental Health Providers, Spotting Risk
The committee chair was enthusiastic about a Hannon Act provision to provide scholarships to students pursuing mental health disciplines — such as psychology, social work, and marriage and family therapy — in exchange for working in veterans health centers for 6 years.
But Moran was disappointed to learn that because of the time it takes to draft and review the language and gain feedback from stakeholders, such as the American Psychological Association, the scholarships likely won’t be available to students until April 2023.
This is 2 years after the date required in the law, he said.
Matthew Miller, PhD, MPH, director of suicide prevention for the VA’s Office of Mental Health and Suicide Prevention, said he could arrange for his staff to meet with the committee to discuss the timeline, which Tester agreed was a good idea.
While senators, on both sides of the aisle and witnesses appeared excited about many of the suicide prevention interventions explored at the hearing, the idea of removing a veteran’s firearm, even temporarily, was not one of them.
Sen. Richard Blumenthal (D-Conn.) noted that about two-thirds of suicides by veterans involve a firearm. Nineteen states have “red flag” laws or extreme risk protection orders, that could allow courts to separate a veteran from his or her firearm for a limited time if the person was deemed to be a risk to themselves or others.
When Barlet was asked whether she favored other states expanding such laws, she instead said she supported lethal means training.
When pressed, she said she would take the question “for the record.”
Porter said he would need to study the issue.
Strengthening Data Collection
Better data can also help identify those veterans most at risk for suicide, Lorraine said.
“Operation Deep Dive,” a 4-year nationwide study conducted by researchers at the University of Alabama and funded by Bristol Myers Squibb Foundation, aims to identify effective data-driven community-led suicide prevention measures. Data collected so far, he said, suggests suicides are being undercounted by 20%-25%, and that overdose is the “greatest contributor to non-natural death.”
Data collection efforts are also enabling researchers to better gauge veterans risk of suicide.
“With our goal of hypothetically being able to say, ‘In Mobile, Alabama, the veteran who’s most likely to take their life has this characteristic, as compared to Tuscaloosa.'”
Lorraine said he looked forward to working with the VA to help identify those traits of vulnerable veterans, to “get ahead of the curve and prevent it.”