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Thursday, February 28, 2019

By Andrew L. Yarrow

We rightfully mourn the approximately 7,000 U.S. members of the armed services who have died in the long wars in Afghanistan and Iraq. Yet, the death toll from more than 17 years of war is slightly less than the yearly total of suicides by active-duty service members and veterans.

Twenty veterans and active-duty military commit suicide every day in the United States. They account for one-sixth of the more than 47,000 Americans who died by suicide in 2017.

Veteran suicide rates are about 50 percent higher than rates among the general population, Keita Franklin, the national director for suicide prevention in the Department of Veterans Affairs (VA), said during a standing-room-only Capitol Hill briefing last month organized by the Men’s Health Network and the Congressional Men’s Health Caucus. Young service members and veterans, as well as vets 55 and older are most likely to kill themselves.

Why is this happening, and why now?

Most veterans and active-duty service members don’t seek help because they don’t want to be perceived as “broken,” hurt their careers, or believe they can solve their problems on their own, according to Dr. Adam Walsh, director of research and program evaluation for the Defense Department’s Suicide Prevention Program. In addition, many veterans are isolated, feeling that there is nowhere that they belong.

During the hearing, Rep. Jason Crow (D-CO), a newly elected Congressman who was an Army Ranger and had served in the 82d Airborne Division, spoke of how the “warrior culture” among those who have been in combat is “a huge barrier to getting the help you need.” Many men, in general, feel that it is “unmanly” to talk about and find help for depression and other mental-health issues. As Rep. Crow emphatically said: “You are not weak to seek help.”

Because veterans have become an ever-smaller proportion of the American population, it may be that they don’t get as much social support as they did a generation or two ago. However, many of the millions of Vietnam War-era veterans were also ignored in the immediate aftermath of the conflict.

Another more recent factor is that suicide prevention outreach by the VA has fallen during 2017 and 2018, according to a recent report by the Government Accountability Office.

More broadly, veteran suicides are undoubtedly part of the disturbing growth of what Princeton economists Angus Deaton and Anne Case have called “deaths of despair,” including opioid and other drug-overdose deaths, in the 21st century. Suicide rates have risen by 21 percent among the general population and 26 percent among veterans between 2005 and 2016. In the overall population, men are 3 ½ times more likely than women to kill themselves, and men commit nearly all military suicides. And, for every suicide, there are 20 suicide attempts, Maureen Elias, assistant director of the Veterans Health Council, said.

Experts have many ideas about how to fight this tragic epidemic.

Walsh and Franklin spoke of identifying risk factors like isolation and financial problems. Any risk factors should be identified at the time of discharge, said Dr. David Gremillion, a former officer, retired professor of medicine at the University of North Carolina, and board member of the Men’s Health Network.

Although the VA and the Substance Abuse and Mental Health Services Administration have a suicide prevention “lifeline,” 1-800-273-TALK (8255), many experts believe such crisis lines have limited benefit. People on the verge of committing suicide are unlikely to find the number and pick up their phones.

The VA has called for more research and education, expanded prevention and treatment efforts, and greater collaboration between all types of suicide-prevention efforts at assessing at-risk veterans’ access to guns. Preventing veteran suicide “also requires effective networks of support, communication, and care across the communities where veterans live and work,” a 2018 VA report said.

As Rep. Markwayne Mullin (R-OK), co-chair of the Men’s Congressional Caucus with Rep. Donald M. Payne Jr. (D-NJ), said: “One percent of our population is protecting 100 percent of our freedoms.” It’s time that we protect current and former service members from the scourge of suicide.

“Whatever is being done now isn’t working,” Gremillion said. “Data on risk factors should be in a national electronic medical records database that all health-care providers can access. When you consider the magnitude of the problem, we need a more comprehensive and systematic process, including discharge assessment, localized outreach, and diffusion of individual veterans’ mental health records to physicians, while protecting patients’ privacy.”

 

Andrew L. Yarrow is a Men's Health Network Advisor, former New York Times reporter, history professor, and policy analyst at several Washington think tanks