On a day when a veteran died by suicide outside a Department of Veterans Affairs Medical Center in Cleveland, lawmakers grilled VA leaders on what they are doing to prevent such deaths, while department officials called for a national approach to reverse the tragic trend.
An unidentified veteran died early Monday morning outside the emergency room of the Louis Stokes VA Medical Center in Ohio, the 7th suicide this year on a VA property and the fourth this month.
Lawmakers pointed to the tragedy while holding a bipartisan press conference on veteran suicides and a rare evening hearing to question VA leaders about their efforts to address the issue.
"One today. Twenty veteran service members, Reserve and National Guard succumb to their invisible wounds every day. ... This is an unconscionable urgent crisis requiring immediate action," said Speaker of the House Nancy Pelosi, D-California.
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With the budget at the VA for mental health services topping $8.6 billion, House Veterans Affairs Committee members sought to determine how the funds are being used and why the estimated number of suicides a day -- 20 -- has not declined after years of investment.
"Twenty deaths a day totaling more than 7,300 deaths per year is unacceptable. That's 1,800 more deaths per year than the 5,429 service members who have been killed in action since 2001," said committee chairman Rep. Mark Takano, D-California. "Both numbers are ... further evidence of a frustrating and persistent problem we have failed to address."
"Our goal should be more than just preventing suicide, it should be helping our veterans to live a life of meaning and joy," said Rep. Phil Roe of Tennessee, the senior Republican on the committee.
According to VA data, the suicide rate for veterans is 1.5 times that of civilian Americans. The number of veterans who died by suicide in 2016 declined slightly from the previous year, from 6,281 in 2015 to 6,079 in 2016. But since the number of veterans in the U.S. also declined, the overall rate has remained stubbornly steady.
Some age groups also are more affected than others: While more veterans from the Vietnam and post-Vietnam era die by suicide, veterans ages 18 to 34 have the highest rate of suicide, at 45 per 100,000 people.
VA officials say that, of the estimated 20 veterans who die each day, an average six are enrolled in the VA's health system and have access to the department's range of services and support. But most, however, don't use VA and some are not eligible for care, include roughly three out of every 20 who are members of the National Guard or Reserve and never federally activated.
Dr. Richard Stone, executive in charge of the Veterans Health Administration, told lawmakers that many former service members are deeply damaged, with 77% having been exposed to combat, and the issue cannot be solved solely through mental health treatment.
"Significant amounts of this relates to personal, financial and relationship problems and loneliness and isolation," he said. "The post-9/11 generation of veterans joined the military knowing they were going to combat. That is a unique individual in America."
Stone said the nation needs a "whole of society approach," one that includes not only government agencies, physicians, mental health providers and social services, but family, friends and neighbors to take part.
Nearly three-quarters of those who attempted suicide said they spent less than an hour thinking about their actions. Roughly one quarter spent less than five minutes. With studies showing that interrupting this thought process actually saves lives, the VA has started a campaign it calls “Be There,” urging family members, friends and former colleagues to pick up the phone, text or send a social media message to their veteran.
The act of reaching out is a “strong preventive factor for suicide,” VA officials said when they introduced the campaign.
“We want to let people know that the things they do every day … help people feel less alone. That’s what this campaign is about -- encouraging people to be there for each other,” former director of the VA’s Office of Suicide Prevention Caitlin Thompson said.
Friends don’t need to bring up the topic if they are uncomfortable with it; they simply can ask how a veteran is doing, buy them a cup of coffee, help them feel more connected, VA officials said.
They also are encouraged to support from the VA Crisis Line, which can offer support and advice for those worried about a friend or family member. And if the veteran is in immediate danger they shouldn’t hesitate to call, Stone said.
"There are those that would like to indict the VA in this process. This is not as easy as me having just a few more policemen to go through the parking lots. This is about a whole of society approach that reconnects veterans that are intensely lonely and with a feeling of hopelessness that results in these acts," Stone said.
In March, President Donald Trump signed an executive order creating a Cabinet-level task force to examine the federal response to veteran suicides and make recommendations on improving the support system.
VA Secretary Robert Wilkie serves as chairman of the group, which has been tasked to draft a national plan to address the problem.
Meanwhile, lawmakers have introduced a number of bills on veteran suicides, some of which will be considered Tuesday in a meeting of the House Veterans Affairs health subcommittee.
They include a bill by Rep. Anthony Brindisi, D-New York, to improve hiring for VA suicide prevention coordinators, and a bill by Rep. Max Rose, D-New York, which would require the VA to notify Congress within seven days of any suicide or attempted suicide at a VA facility.
Other pieces of proposed legislation include:
- A bill by Rep. Conor Lamb, D-Pennsylvania, to promote a "whole health" approach to medical treatment at the VA that includes complementary and alternative therapies.
- Legislation from Roe and Rep. Mike Levin, D-California -- the Vet Center Eligibility Expansion Act -- which would give members of the National Guard, Reserve and Coast Guard access to care at certain VA facilities known for individualized care.
- The Veterans Equal Access Act, introduced by Rep. Earl Blumenauer, D-Oregon, which aims to increase veterans' options for pain management by allowing VA health care providers to refer veterans to state marijuana programs.
- A bill from Sen. Jon Tester, D-Montana, ranking member of the Senate Veterans Affairs Committee, and Sen. Jerry Moran, R-Kansas, that would seek to add mental health professionals at the VA by giving the department direct hiring authority and offering scholarships to mental health professionals to work at Vet Centers.
During the hearing, Rep. Kathleen Rice, D-New York, quizzed officials on access to weapons and whether the VA provided any guidance or services to veterans who would like to reduce their access to firearms.
"We can't adequately address the issue without talking about firearms," Rice said. "Sixty-nine percent of veterans have completed suicide via firearm. Women veterans are also more likely to utilize a firearm. It's been proven that restricting access may reduce suicide risk. Has the VA studied gun violence in the veteran population?"
VA's National Director of Suicide Prevention Keita Franklin said the VA trains its providers on how to talk to veterans about access to lethal means, including weapons and mass quantities to medication. It also maintains a partnership with the National Shooting and Sports Foundation to train gun shop and range instructors on the issue.
Takano promised that Monday's hearing would be the first of several on suicide among service members and veterans, including a future meeting that would bring VA and Defense Department representatives to testify.
He described the issue as deeply personal: When he was a child, an uncle who was a Vietnam veteran died by suicide. "His suicide still haunts me from time to time to this day," Takano said.
The Veterans Crisis Hotline is staffed 24 hours a day, seven days a week, at 800-273-8255, press 1. Services also are available online at www.veteranscrisisline.net or by text, 838255.