Examining the Progress of Suicide Prevention Outreach Efforts at the VA
Mr. Chairman, Ranking Member, and members of the committee, on behalf of Iraq and Afghanistan Veterans of America’s one hundred and eighty thousand members and supporters, thank you for the opportunity to testify before you today. My name is Tim Embree. I am from St. Louis, MO and I served two tours in Iraq with the United States Marine Corps Reserves. Veteran suicide is an issue that resonates with all of our members and we are grateful that you are holding this hearing. As an IAVA member recently told us:
“For most of the past year I thought about suicide almost every hour of every day, and I felt so ashamed for this. I wondered what was wrong with me, why I couldn't get rid of it.” – IAVA Member
And this issue is of particular importance to me because I lost one of my Marines to suicide in 2005.
The Most Dangerous Part Of Going To War These Days Is Coming Home.
“Since my return, I have lost 2 close friends to suicide, 2... I said 2, from my platoon. That is the sick reality.” – IAVA Member
Last year, more U.S. servicemembers died by their own hands than in combat in Afghanistan. Most Iraq and Afghanistan veterans know a fellow war fighter who has taken their own life since coming home. The numbers do not even include the veterans who commit suicide after their service is complete. They are out of the system and their deaths are often unknown and uncounted. Recently the Army Times reported “18 veterans commit suicide each day… an average of 950 suicide attempts each month [are] by veterans who are receiving some type of treatment from the Veterans Affairs Department” . Worse yet, the Department of Defense
(DOD) recently released numbers showing that we are on track to surpass last year’s 30-year-high suicide rate.
As the suicide rate of our servicemembers and veterans continues to increase, without any signs of abating, we must acknowledge that suicide is only one piece of the mental health epidemic plaguing our returning war fighters. Left untreated, mental health problems can and do lead to substance abuse, homelessness and suicide. A 2008 RAND study reported that almost 20 percent of Iraq and Afghanistan veterans screened positive for Post Traumatic Stress Disorder (PTSD) or major depression. A recent Stanford University study found that this number might actually be closer to 35 percent. Compounding the problem is the fact that fewer than half of those suffering from mental health injuries are receiving sufficient treatment.
Suicide Hotline is a Real Lifesaver.
The VA National Suicide Prevention Lifeline (800-273-TALK) is a 24-hour hotline for veterans in crisis, which fields nearly 10,000 calls a month. These calls have rescued more than 7,000 veterans wrestling with suicide. IAVA proudly supported the Joshua Omvig Veteran Suicide Prevention Act which established this important hotline. Our members continually inform us that they have used this valuable service for themselves and have referred it to their friends.
We know this because IAVA hosts an online community for Iraq and Afghanistan veterans to connect. Across the country, through CommunityofVeterans.org, they share their challenges and support one another as only they can. CommunityofVeterans.org also connects veterans with private and VA mental health support information – including the VA National Suicide Prevention Lifeline. Recently a veteran asked,
“How often do YOU think of suicide? It kinda creeps up on me every couple of days, I toss the idea in my head around a little bit, then tuck it away again till the next time. It mildly disturbs me because I don’t WANT (consciously) to kill myself, but sometimes it just seems easier.” – IAVA Member
One of the many veterans who reached out to this vet responded,
“Maybe you should call that National hotline, just to ask a couple more questions. I am pretty sure it's a free service, and they're there to listen a bit, and could tell you if it's more serious or not.” – IAVA Member
For a veteran considering suicide, the act of reaching out to those close to them can often seem overwhelming. The act of a simple anonymous call to the VA’s National Suicide Prevention Lifeline might be enough to save the life of a veteran who is sitting alone, with a gun and a bottle of booze. Veterans in these desperate situations can’t wait for regular business hours to seek help. Thankfully, the National Suicide Prevention Lifeline is available 24 hours a day, 7 days a week.
The National Suicide Prevention Lifeline recently added a live chat feature which allows veterans to express their fears, anger, and sadness in a confidential manner, 24 hours a day, with a trained professional on-line. This on-line chat is a good way to reach suffering veterans not reachable through the hotline.
“When the online counselor said, ‘I hear you’ I knew I was going to be ok,” – IAVA Member
Outreach, Outreach, Outreach.
The Department of Veterans Affairs must develop a relationship with servicemembers while they are still in the service. Like many successful college alumni associations that greet students at orientation and put on student programs throughout their time in college, the VA must shed its passive persona and start recruiting veterans and their families more aggressively into VA programs. Once a veteran leaves the military, the VA should create a regular means of communicating with veterans about events, benefits, programs and opportunities. If a veteran received half as many letters and emails from the VA, as college grads do from their alumni association, we would be getting somewhere.
Moreover, the VA must aggressively promote all VA programs and reach out to veterans who have yet to access their VA benefits.
“The VA could be more aggressive in contacting OIF/OEF veterans and at least talking to them before the veteran has a mental health crisis. They need to be proactive instead of reactive.” – IAVA Member
To begin the shift from a passive to an active agency, IAVA believes the VA must prioritize outreach efforts and include a distinct line item for outreach within each VA appropriation account. This line item should fund successful outreach programs such as the OEF/OIF Outreach Coordinators, Mobile Vet Centers, and the VA’s new social media presence on Facebook and Twitter. In their current forms, these outreach programs are much too small to make a transformative difference. IAVA was disappointed that there were only a few brief mentions of outreach activities in the President’s VA budget submission. Regrettably, none of them were to a dedicated outreach campaign.
The VA’s current outreach campaign is disappointing. When the VA announced that it had placed ads on more than 21,000 buses nationally, to spread the word about the suicide prevention lifeline, we were initially enthusiastic; an image of the ad is below. When we saw the ad, it was clearly a failure. The ad has over 30 small print words; the average bus ad is limited to 5-10 words. In the short time in which a bus passes, a veteran would have to go by the bus repeatedly to even read the hotline number.
IAVA has run one of the largest non-governmental outreach campaigns in history, through a partnership with the Ad Council and some of the world’s best advertizing firms. We have learned a lot about the best ways to communicate complex and serious issues through television and print. We are ready to work with the VA and share our expertise.
The World’s Best Mental Health Program Will Still Fail If No One Uses It.
The heavy stigma associated with mental health care stops many servicemembers and veterans from seeking treatment. More than half of soldiers and Marines in Iraq who tested positive for a psychological injury reported concerns that they will be seen as weak by their fellow servicemembers. One in three of these troops worried about the effect of a mental health diagnosis on their career. Even in an anonymous survey we conducted in December of last year, more than 10% of our members selected “prefer not to answer” in response to the question of whether they had sought care for a mental health injury. It is easy to conclude that those most in need of treatment may never seek it out.
“A paradigm shift must occur.... ‘you're a whimp if you see the wizard’ needs to go away and be replaced with ‘everyone needs someone’.” – IAVA Member
To end the suicide epidemic and forever eliminate the stigma associated with combat stress, the VA and DOD must declare war on this problem. They must launch a nationwide campaign to combat stigma and to promote the use of DOD and VA services such as Vet Centers and the National Suicide Prevention Lifeline.
This campaign must be well-funded, research-tested and able to integrate key stake-holders such as veteran service organizations and community-based non-profits. Furthermore, the VA must develop and aggressively deploy combat-stress injury training programs for civilian behavioral health professionals who treat veterans outside of the VA (e.g., college counselors, rural providers, behavioral health grad students, and professional associations).
The VA must allocate specific resources toward battling this dangerous stigma, or we will never see a critical mass of veterans coming in to seek help.
Department Of Veterans Affairs, IAVA Has Your Back.
Through our own historic Public Service Announcement (PSA) campaign with the Ad Council, IAVA has learned a lot about stigma busting and veteran outreach campaigns. Millions of Americans continue to see our iconic PSAs, like the one featuring two young veterans shaking hands on an empty New York street.
“The Iraq and Afghanistan Veterans of America brilliantly portrayed this feeling of isolation in a 2008 ad where a soldier returning from the war walks through an empty airport. He continues through downtown Manhattan, which is also completely empty. No cars. No people. It isn't until a young veteran approaches the soldier with a handshake, a smile and pat on the back saying, ‘Welcome home, man,’ that the street becomes populated.
I was a bit shaken the first time I saw it, as it immediately resonated with me. It hit an exposed nerve, and I knew that those guys at the IAVA ‘got it.’ They knew exactly where we were coming from.
The problem, of course, is that we, as veterans, live the rest of our young lives in the ‘civilian’ world and not on the battlefield. It took me several months to fully comprehend this. After realizing that my sense of isolation was alienating me from those I loved, I made the conscious decision to use my experiences in combat as a source of great strength, versus letting them become a weakness.”
The TV ads are just one component of this groundbreaking campaign. They are complemented by billboards, radio commercials, and web ads which have blanketed the country and touched countless Americans. In just the first year of the campaign, IAVA secured $50 million in donated media while reaching millions of veterans and their families.
This campaign is an example of the innovation coming out of the VSO and non-profit communities, which the VA should treat as an asset. This cutting-edge campaign directs veterans to an exclusive online community, mentioned above, that strongly shows our nation’s new veterans that “We’ve Got Your Back”. It also directs them to a wide range of mental health, employment and educational resources—operated by both private non-profits and the Department of Veteran Affairs. Innovative, aggressive outreach programs like this should become part of the new VA culture and they can fuel-inject outreach efforts. IAVA is learning what works, and we want to share our knowledge.
“Eight Weeks To See A Counselor?”
“It took me over 6 months for a mental health appt through VA and this was after I told them I was having suicidal and homicidal ideations. I’m still waiting now for some appointments.” – IAVA Member
Convincing a veteran to overcome his fear of ostracism and choose to seek help is an uphill battle. We must ensure that when they do seek treatment, there is ready access to the necessary care. Regrettably, many of our veterans have complained about long wait times and inconvenient hours.
The VA must focus on dramatically increasing the number of mental health providers within the Department of Veteran Affairs. This increase will reduce wait times and improve overall quality of care.
“I went 80 miles to the local VA outpatient treatment facility, they did not have anyone on staff to talk to. They have group meetings, but again, its 80 miles roundtrip and I would have to be there by 4. I work till 5. That means that I would have to leave almost 2 hours early to drive 80 miles roundtrip just to talk to someone who had a similar experience. I can't do that.” – IAVA member
“We need a ‘surge’ of mental health professionals! It is time the rest of the country steps up and begins to sacrifice as well.” – IAVA Member
Additionally, IAVA supports creative solutions for rural veterans. Many veterans live too far from local VA facilities to receive treatments at traditional brick and mortar VA facilities. We support contracting with local community mental health clinics and extending grants to groups that provide programs such as peer-to-peer counseling. Veterans must be able to receive mental health care near their personal support system, whether that system is in New York City or Peerless, Montana.
Our veterans are facing a mental health epidemic. Unless we address the overall issue of mental health stigma, we will never be able to stem the growing tide of suicides. The VA and DOD have created many programs that are extremely effective in helping servicemembers and veterans who are hurting. But great programs are worthless if servicemembers and veterans don’t know they exist, can’t access them, or are ashamed to use them.
IAVA is proud to speak on behalf of the thousands of veterans coming home every day. We work tirelessly so veterans know we have their back. Together, with this Congress and the Department of Veteran Affairs, every veteran must be confident that America has their back.
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