The factors that lead to someone contemplating suicide are complex and diverse. It is critical that an evidence-based approach remains at the center of all legislative funding decisions and roll-outs of new policy.
Although veterans comprise only 7.9 percent of the U.S. population, they account for 13.5 percent of all U.S. adult suicide. From 2008 to 2016, there were more than 6,000 veteran suicides each year, according to research conducted by the Department of Veterans Affairs. Many of these men and women suffer from the visible and invisible wounds of war and are hesitant to receive the care they need.
Our nation can change these statistics and steps have been taken in Washington to do so. In the past two years, President Donald Trump has issued two Presidential Executive Orders and supporting legislation has been introduced in Congress. These tools could be instrumental to reducing veteran suicide rates. Unfortunately, challenges still remain.
Of the 20 veterans who die by suicide each day, about 70 percent have little or no contact with the federal system in the two years prior to their death. One of the two executive orders, the 2019 Presidents Roadmap to Empower Veterans and End Suicide, and supporting legislation are generating solutions for increasing community engagement in solving the problem. These efforts include a community grant program, which is in line with the National Strategy for Preventing Veteran Suicide 2018-2028.
While promoting expanded community partnerships is a positive step, we recommend that the coordination of these community programs be done through the VA. This will ensure resources are optimized and services are not duplicative of already existing and effective programs.
Furthermore, the grant program will be modeled after the successful U.S. Department of Health & Human Services homelessness grant program. We draw caution and want to ensure the differences between homelessness and suicide are recognized. Homelessness is a geographically driven issue, while suicide is not. It is imperative that legislation outlines transparency and accountability measures, and prioritizes proven approaches to preventing suicide among veterans.
Additionally, evidence-based approaches should be prioritized in the community grants legislation. A successful policy solution would have three main thrusts:
First, a portion of the funds in the grant program must be invested in organizations delivering evidence-based mental healthcare. This will increase the number of veterans who access these treatments.
Research tells us that evidence-based treatments for post-traumatic stress and depression reduce suicidal ideation and risk. While the VA has invested heavily in training its providers in research-based interventions, the availability of evidence-based mental healthcare outside of the VA is inadequate. Congress can look to programs like the George W. Bush Institute’s Warrior Wellness Alliance as an example of how to connect more veterans to effective care when they need it.
Second, funds need to be appropriated to programs that reduce access to lethal means and promote safety. Of veterans who die by suicide, 70 percent use a firearm. Additionally, data indicates that those who use a firearm in an attempt die 85 percent of the time, and those who use overdose only die 2 to 4 percent of the time. Meanwhile, 90 percent of those who survive a suicide attempt, do not go on to attempt in the future.
In looking to other countries, the Israeli Defense Forces requires soldiers to store their firearms on base before weekend leave. The overall suicide rate has dropped 40 percent. Voluntary, temporary safe storage of firearms for at-risk individuals has been endorsed by the U.S. Office of the Surgeon General as a strategy for reducing suicide rates. Like other social policy interventions designed to make our environments safer, such as airbags and pill bottle locks to name a few, programs and policies to promote safe storage of firearms are essential to any comprehensive suicide prevention effort.
Finally, screening for suicide historically has relied on veterans disclosing they are suicidal. Typically, this happens within the health care setting through self-report assessments. This is an outdated system that can be modified to include innovative analytics.
Data analytics advancements such as the VA’s REACH VET, Army STARRS, and Qntfy, a group working with the Bush Institute’s Warrior Wellness Alliance, have led to innovative tools to identify those at risk of suicide before they are in crisis. The grant making legislation needs to prioritize the utilization of such innovative tools responsibly, ethically, and in partnership with community care providers and veterans.
The factors that lead to someone contemplating suicide are complex and diverse. It is critical that an evidence-based approach remains at the center of all legislative funding decisions and roll-outs of new policy. And with the right prioritization, transparency, and accountability, VA and government leaders can make an impact. It is far too late for scattershot approaches. Anything less is unacceptable.
