The Veterans Health Administration has tried a number of ideas to drive down the suicide rate among veterans.
The VA is about to start automatically enrolling most new veterans in mental health care, starting in March. People who work with veterans say the program, mandated by an executive order from the White House, is a great idea, but they worry about the impact on an already strained system.
VA Secretary David Shulkin has made suicide prevention one of the main efforts of his administration. A VA study found that of the 20 veterans who commit suicide each day, 14 are not enrolled in VA care.
Phillip Faustman almost became a part of that statistic. Faustman, who is gay, joined the army in 2012 after the end of the "Don't ask, don't tell" policy, which barred gay and lesbian troops from serving openly in the U.S. military.
“I waited for the repeal. So, I joined the army to prove to myself that I could do it,” he said.
While in the military, he suffered sexual trauma that led to a diagnosis of post-traumatic stress disorder and depression. Discouraged, he left the military in 2015, he said.
“When I first got out, I was alone and no one was really helping me. I didn’t really feel like I was connected to anybody. So, I had my suicide attempt,” he said.
Enrollment process was daunting
Periodically homeless, Faustman did not turn to the VA. He found the enrollment process daunting and he lost his paperwork. Instead, the San Diego native said he tried a private clinic in New Orleans.
“It was a religious program but I didn’t realize how religious,” he said. “They didn’t believe in homosexuality. Every day was just berating. It just wore on me.”
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The year after a veteran returns to civilian life is a vulnerable time. Veterans describe the experience of leaving the service like losing a family. Veterans in this first year have a higher suicide rate than the overall veteran population.
For the last two weeks, Faustman has been getting care and a place to stay through a temporary homeless shelter run by Veterans Village in San Diego.
Veterans Village helped
Faustman counts three suicide attempts in two and a half years. The last couple of weeks have been much better. Veterans Village helped him apply for his military paperwork and now he is enrolling with the VA. He just wishes help had come sooner.
“I would have had that immediate access to seeing the doctor, to receiving the care,” Faustman said.
The VA has tried several ways to get at the suicide problem among vets. The latest effort to target veterans leaving the service is an executive order, announced by the White House. The VA will target that group by automatically enrolling nearly all transitioning veterans into VA mental health care for 12 months.
Kimberly Mitchell is the president and CEO of Veterans Village. She sees cases like Faustman’s regularly. Not every veteran struggles after leaving the service, but those who do can be hard to reach.
“In the military, you’re taught to work things out on your own,” she said. “You’re taught to figure out solutions. In other words, suck it up. Unfortunately, that same attitude transitions with that service member.”
Risk factors for suicide
Carolyn Allard headed the VA San Diego program on sexual and interpersonal trauma until she left for private practice six months ago. She has seen the risk factors for suicide among her clients.
“They are at high risk for having the mental health condition that contributes to it, like PTSD, post-traumatic stress disorder,” she said. “Like depression, which goes hand in hand with PTSD often. They’re also at high risk for traumatic brain injury, which is also a risk for suicide.”
The VA has extensive experience in treating those risk factors. One year of treatment can make a difference, she said.
“It can, actually,” she emphasized. “Some of our most effective treatments for PTSD take 12 weeks on average.”
Coordinating efforts
The problem is that the VA and the military have always struggled to coordinate their efforts. The executive order signed by President Trump requires the VA to automatically enroll new veterans in mental health care within 60 days. Allard and others who work with veterans worry that it is not enough time to complete the enrollments.
“Ah, I don’t see it happening very quickly,” she said. “The VA is a big, huge bureaucracy. Like any other bureaucracy, things do not move fast.”
The VA has not outlined how the new program will work, but officials have released a few key details. The VA estimates the program will end up serving 32,000 veterans out of the more than 250,000 people who leave the military each year. Senior administration officials estimate it will cost more than $100 million to serve the additional veterans. No new money is being allocated.
The challenges are similar to those faced by an earlier health program for veterans. After Congress gave the VA 90 days to create a new program to allow veterans to see private doctors, the VA struggled with long wait times and bureaucratic delays. The 2014 Veterans Choice law was designed to lessen wait times but problems persist.
“When you’re talking about a few million people getting out over the next five years, and offering them service, you had better be able to take care of those who are in the system and need the services,” said Sherman Gillums Jr., a retired Marine who helped veterans file for benefits in San Diego before becoming the chief strategy officer for AMVETS.
He is worried about the implementation of the new executive order.
“Mental health care is an area where the Department of Veterans’ Affairs needed to do a lot of work,” he said.
AMVETS, an organization that works on behalf of veterans issues, has also worked to provide basic benefits for veterans with less-than-honorable discharges, who also have a high suicide rate. A separate VA program started last year allows vets who do not qualify because of their status to go into VA emergency rooms and to receive up to three months of mental health care. The VA says 3,200 vets took advantage of the VA’s offer.
Groups like AMVETS are anxious to see how easily the VA can assimilate the much larger group covered by the executive order. They will find out quickly.
The White House deadline is March 9.
