Veterans and suicide: A national issue with local consequences
That’s the estimated number of veterans in the United States who died by suicide every day in 2010, according to a February 2012 report from the U.S. Department of Veterans Affairs.
A St. Cloud Times analysis of state death records found that 686 veterans died by suicide in Minnesota from 2007 to 2012. Almost 19 percent of suicides in Minnesota during those years were veterans, which closely tracks the national numbers.
Veterans also are dying from suicides at a higher rate than the general population, according to the Times analysis. The average rate of veteran suicides in Minnesota during that six-year period was 30 per 100,000 people, almost double the suicide rate of the overall population of 15.4 per 100,000.
Mary Jo Pine
One of the people working to prevent needless deaths is Mary Jo Pine, suicide prevention coordinator for the St. Cloud VA Health Care System.
The suicide prevention program in St. Cloud was started in 2007 when the Joshua Omvig Veterans Suicide Prevention Act was signed into law. Omvig was an Iraq veteran from Iowa who suffered from post-traumatic stress disorder and died from suicide in 2005.
The law named for him required the Department of Veterans Affairs to establish a comprehensive program for suicide prevention among veterans. That included designating a suicide prevention counselor at each VA medical facility.
Before the law was passed, “there wasn’t a consistent way of monitoring and tracking individuals and following up,” Pine said. “Even though it was being done, there wasn’t the pattern of consistency.”
A typical day for Pine starts when she checks her inboxes. If a veteran called the crisis line during the night and a consultation was requested, Pine will be notified in three ways. She has 24 hours to follow up.
About two years ago, the VA changed the name of its suicide prevention hotline to the veterans hotline.
“They realized that veterans can go into crisis for many different reasons, and they may not at all be associated with suicide,” Pine said. “Plus, they wanted to get people to call before they got to that suicidal point.”
The change resulted in an increase in calls to the national crisis line. When veterans call, there’s always someone available to talk, Pine said.
“Our veterans are never, ever put on hold,” she said.
“Our veterans are never, ever put on hold,” she said.
Some veterans call just to talk, or because of legal issues or problems with benefits. In those cases, Pine might not be notified. But often she does call to help, knowing that if those issues aren’t resolved, the veteran could go into a suicidal crisis.
“It’s finding resources for them, people they can call who might be able to help them,” Pine said. “It’s just meeting them where they’re at.”
The number of calls she takes in a week can range from three to as many as 15. A big part of her job is listening.
“It decreases their anxiety, it kinds of normalizes what they’re experiencing and it actually decreases their suicide risk,” she said.
After Pine completes her morning calls, she visits veterans in the inpatient unit. For any patients who attempted or contemplated suicide, Pine looks at their treatment plan. If they are at high risk, their record is flagged for 90 days. Every week for the next four weeks, flagged veterans must be seen by a mental health provider who will assess their suicide risk and review their safety plan with them.
The safety plan is a way for veterans to recognize warning signs and use coping strategies and sources of support to stay alive when they’re hit with a suicidal crisis.
“I’ve gotten letters from veterans that really didn’t believe that it would work, but they used it,” Pine said. “I’ve gotten two letters where they said, ‘I can’t believe it really, really does work.’”
Pine also makes sure that before a veteran leaves the hospital, there’s a follow-up appointment scheduled with a mental health treatment coordinator and plans for any other treatment needs.
If high-risk patients don’t show up or cancel an appointment, staff follow up with phone calls, call family members or do a health and welfare check, Pine said.
Risk factors vary, but can be as simple as being an older white man — the group at greatest risk for completing suicide. Other factors can include addiction, mental or physical health issues, relationship problems and a sense of hopelessness, Pine said.
“Somebody can be at elevated risk without ever having a suicidal thought, plan and intent,” she said. “Why we take that seriously is because we know that about 70 percent of suicides are an impulsive act at that time.”
Whether a veteran has combat experience also can be a factor, although there have been numerous suicides among veterans who never deployed overseas. There’s some evidence that the number and intensity of deployments can increase suicide risk, but it depends on the person, Pine said.
“It’s not just the deployments. It’s the individual and how they’re able to deal with those deployments,” she said.
Substance abuse also is a major risk factor. Pine noted that many people who engage in suicidal behavior, such as contemplating, planning or attempting suicide, do so when they are intoxicated but would never think about it when they are sober.
“Sobriety is everything, because alcohol in particular is a depressant,” she said. “If they’re depressed already, it’s going to make them more depressed.”
VA staff also look at a veteran’s support system. Many veterans who are at risk of suicide have expressed feelings of not belonging, not having a purpose and feeling like they are a burden to others, Pine said.
“That’s why we have this huge thought about keeping people connected,” she said. “It’s that connectedness that puts that safety net under that person.”
Pine tracks the number of fatal and nonfatal events on a monthly basis. A non-fatal event could be a veteran having serious suicidal thoughts, or an overdose even if it’s not clear whether it was a suicide attempt.
Suicide rates for the population as a whole have been on the rise in recent years. While the number of veteran suicides has increased, the percentage of suicides committed by veterans has remained steady at about 18-22 percent, Pine said.
While it’s often thought that younger people are most at risk for suicide, between 1999 and 2010, the average age of male veterans who died by suicide was 59.6 years, according to the Department of Veterans Affairs.
Although Pine is the designated suicide prevention coordinator, all VA staff are trained to respond if a suicidal veteran calls.
“We believe and we train people that it is everybody’s business to monitor somebody, to know somebody who might be at risk, and to get them some help and give them the help,” she said.
The VA has been criticized in the past for not doing enough to address veteran suicide. Pine said as officials have learned more, policies have changed.
“There’s always going to be things that we’re learning,” she said. “People are still killing themselves, and one death is too much from my perspective. There’s much more to do. But yet, we have made a lot of progress.”
Talk About It
Share stories and strategies for coping in a new online place for Central Minnesota veterans and their families at www.facebook.com/scarsofservice
Follow the #ScarsofService hashtag on Twitter.
And join the discussion as Terry Ferdinandt and Hector Matascastillo take questions from readers on sctimes.com.
About the reporters
Kirsti Marohn has been a reporter at the St. Cloud Times since 1998. She has covered local and state government, social issues and the environment. Her father was a U.S. Marine and her husband served in the Minnesota National Guard prior to 9/11.
Marohn became interested in writing about veterans after hearing about the struggles many have faced since returning from Iraq and Afghanistan, and how community resources were not always adequate to help them.
You can follow Marohn on Facebook and on Twitter @kirstimarohn.
David Unze has been a reporter at the St. Cloud Times since 1997. He has covered primarily courts, public safety and higher education.
The problems that Iraq and Afghanistan veterans face came to his attention through the interactions that police and the courts have with veterans in crisis. He also learned about the challenges that vets face when they return home and try to resume their education.
You can follow Unze on Facebook and on Twitter @sctimesunze.