Veterans Affairs Secretary Eric K. Shinseki said his agency is working with the Defense Department to end veteran homelessness and to identify possible contributors to service member and veteran suicide.
On the first day of the June 20-22 Annual DOD/VA Suicide Prevention Conference in Washington, D.C., Shinseki – a retired Army general, former Army chief of staff and a combat-wounded Vietnam veteran – took the stage to a standing ovation from hundreds of mental health professionals, clinicians and military leaders.
“Suicide is a national concern. The Centers for Disease Control’s annual report on the top 10 leading causes of death … lists suicide as one of the top four causes of death in Americans ages 10 to 54,” Shinseki said.
Suicide is the second-highest cause of death for young people ages 25 to 34, he added.
“These also happen to be the recruiting years,” the secretary said. “Should we be surprised that recruits out of such a population bearing some level of increased stress for much of the past decade would experience suicides at some elevated level, or that the suicide rate among male veterans appears to be almost twice that of the general population?”
Shinseki said intervention, or the act of interrupting a potential suicide, primarily is a reactive response.
“We have demonstrated that we can react well,” the secretary told the audience, “but is that good enough for the long term?”
To aggressively tackle some potential precursors of suicide, officials said, the VA is focusing on veteran homelessness and on creating a “warm handoff” for service members who transition from the military to the VA.
Three years ago, Shinseki said, the VA made ending veterans homelessness by 2015 one of its key priorities “because homeless veterans are evidence, no matter how good we think we are at this, that we have gaps in our system of care and benefits.”
The VA team decided to challenge all of its assumptions about homelessness to find and close those gaps, he said.
“Many experts on homelessness felt then that the primary contributor to homelessness was mental illness. Today, after nearly three years of work, they’ve concluded that the leading contributor to veteran homelessness is more specifically substance abuse. That gives us a target to go after.”
He added, “My question to this audience is, have we made similar assumptions about suicides over time? Do we know causes, cures and measures of effectiveness in our treatment regimens for those vulnerable to suicide? Do we have sufficient tools to prevent as well as rescue when dealing with those at risk? Are we asking the right questions to challenge all of our assumptions about suicide ideation?”
Veterans suffer disproportionately from depression and substance abuse, and they are high on the list for joblessness as well, Shinseki said. All of these factors, he added, contribute both to homelessness and suicide.
Another focus at VA is the transition of the service member to veteran, and how that process works for those who may be vulnerable to suicide or its precursors.
“At VA we know that when we diagnose and treat, people get better. This is reflected in our suicide treatment data that shows a declining trend between 2001 and 2009, the last year for which we have verifiable data,” the secretary said.
“But we also know that veterans who commit suicide, perhaps as many as two out of three, are not enrolled in the VA health care system,” he added. “So as good as we think our programs are — we don’t even get a shot at these veterans.”
To narrow this gap, Shinseki said, efforts at the VA must focus on aggressive outreach to veterans and families, and the provision of high-quality and cutting-edge mental health treatments to those in need.
“We do this best with ‘warm handoffs’ between [DOD and VA],” he added, referring to a fledgling process through which a health care liaison is tasked to collect transitioning service members’ medical records, make initial appointments in an appropriate VA medical center, and facilitate a personal handoff to the new facility.
“VA will continue to work closely with DOD to strengthen our collaboration on behalf of veterans leaving the service and reservists returning from operational deployments,” Shinseki added. “We simply must transition them better.”
He added, “There are folks still not convinced that warm handoffs are key to preventing suicides.”
In May, Shinseki and Defense Secretary Leon E. Panetta met in Chicago to announce the goal of creating a fully operational integrated electronic health record that seamlessly will be able to move from DOD to VA by 2017.
“A significant challenge,” Shinseki said, “but without it these warm handoffs are just more difficult.”
Shinseki said VA investments in mental health programs increased from $4.4 billion in 2009 to $5.9 billion in 2012.
“Our funding specifically for suicide prevention has doubled, from $35.8 million in 2009 to $72.8 million in our 2013 budget request, with $6.2 billion requested for 2013 for overall mental health,” he said.
As DOD anticipates growth in its mental health patient load, Shinseki said, the VA will pace its own growth accordingly.
“But that takes warm hand offs or else we’re stuck in that primarily reactive response of rescuing [those who attempt suicide] during crisis, he added.
“Secretary Panetta’s leadership and close partnership on behalf of those who wear the uniform today and those who have worn the uniform in times past has been monumental,” Shinseki said. “As a result, weâ€™ve brought our two very large departments much closer together than theyâ€™ve ever been before.â€