Program to Prevent Suicide by Veterans Earns Bipartisan Support

PHOENIX — Gloribel Ramos sunk slightly under the weight of her 32-pound body armor and gingerly gripped a plastic facsimile of an M4 rifle as she prepared to watch a video of a roadside bomb detonated in Iraq, all so she could better understand the experience of war and its impact on people who have fought in one.

Along with about three dozen other people gathered here, she had joined an effort to stem veteran suicide, one heavily reliant on civilians in the community willing to take the time to learn the warning signs rather than depend only on the Department of Veterans Affairs, which has for years failed on its own to turn the tide of veteran suicides.

The program, called Be Connected, represents a rare — and quiet — spot of bipartisan cooperation between congressional Democrats, who are highly critical of so much of the president’s policy, and the Trump administration, which has moved aggressively to try to turn around the intransigent veteran suicide rate.

“We are working well with them,” said Representative Mark Takano, Democrat of California and the chairman of the Committee On Veterans’ Affairs, referring to the department. He specifically cited the Be Connected program, which focuses on reaching veterans at risk for suicide, whether they live on a Native American reservation at the bottom of the Grand Canyon or in this bustling city.

Veterans died by suicide at roughly one and a half times the rate of the rest of the American population in 2017, according to data released Friday by the Department of Veterans Affairs. More than 6,000 veterans took their own lives each year between 2008 and 2017, and roughly 20 a day since 2014, according to the statistics.

There has been increasing awareness that suicidal veterans often are best reached through members of their own community, and not the federal government. Some of those veterans who may need help do not seek Department of Veterans Affairs services, and some suicides stem from issues not related to military service at all.

In March, President Trump issued an executive order to reduce the suicide rate by assigning other federal agencies — like the Agriculture Department in rural areas — to get involved, and enlisted local governments, veterans groups and social service organizations to pitch in.

The approach is a shift for an agency that for years attacked the problem alone, and it has impressed even the Democratic chairman of the House Committee on Veteran Affairs, who has been relentlessly critical of the department, especially over the issue of veteran suicide.

The program, called Be Connected, is based on one that worked with Arizona National Guard members who were dying by suicide at increasingly high rates over the last decade, and supported by a 2015 law designed to improve veteran’s mental health. It is operated by the Arizona Coalition for Military Families, a statewide public-private partnership that includes the Arizona governors office, the Arizona Department of Veterans Services, the federal veterans department and other partners. It is funded by a combination of federal, state, foundation and corporate sources.

There were roughly a dozen National Guard deaths in 2010 in Arizona; that fell to zero a year after the program began, said Thomas Winkel, director of the Arizona Coalition for Military Families, the backbone of the consortium.

The philosophy, he said, is to intervene on “the myriad issues that service members and their families struggle with” before they “lead to crisis.” Two years ago, the veterans department became an official partner in the consortium, which has since received 10,000 calls.

By identifying veterans who have the kinds of struggles that often lead to suicide, the program can connect them with the services they need while they still can be helped, like therapy, health care or a pet sitter to take care of their animals as they seek substance abuse treatment.

“It’s not just about health issues,” said Wanda Wright, the director of the Arizona Department of Veterans’ Services. “It’s about all the determinants in your life that are barriers to services.”

The person to identify them comes from the community, like Ms. Ramos. They could be a doctor or nurse, or a civilian “navigator” such as a homeowner who spent the last few days chatting with his house painter, one who might happen to be a deeply troubled veteran. Those who sign up for navigator training might work for a state social service agency or a health care provider. But they might be just a family member of a veteran, or anyone else interested in helping veterans.

Calls to a central telephone line are categorized by nine different “social determinants” related to health care, finances and other issues. A database is home to information on the veterans who are served to help refine the program.

Department officials hope the program will funnel more veterans into its services, since nearly 64 percent of vets who die by suicide are not connected to the veterans department’s health care system.

“We do see a decrease for vets treated in the V.A. who are diagnosed with depressive disorder,” said Dr. Matt Miller, the acting director of the V.A.’ s Suicide Prevention Program.

While the number of overall veteran suicides was highest among veterans 55 to 74 years old, accounting for 38 percent of all veterans deaths by suicide, veterans between 18 and 34 had the highest suicide rate in 2017, with 44.5 deaths per 100,000, a 76 percent increase from 2005.

There remain troubling trends among female veterans as well. After adjusting for age, the 2017 rate of suicide among women veterans was over two times the rate among women who were not veterans.

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Robert L. Wilkie, the secretary of veterans affairs, has repeatedly called veteran suicide his “No. 1 clinical priority.” He was confirmed in July 2018 and has spent much of his first year traveling to areas where the problem is particularly acute and putting together a team to attack the issue.

In the 2019 fiscal year, the department’s suicide prevention office is on track to spend $47 million, $20 million of which is allotted for outreach.

The agency’s prevention office had been in turmoil in recent years. Caitlin Thompson, its previous director, resigned in 2017 after tangling with political appointees. According to a Government Accountability Office report last year, the office has essentially languished, and spending on some outreach efforts had declined 77 percent since 2015, enraging lawmakers who thought the agency was letting the issue fester.

There is no data yet to demonstrate the program that worked so well on a small scale with National Guard veterans will reduce suicide nationally, but veterans department officials believe hard evidence will come.

“One of the biggest things in the executive order is that it moves the discussion of suicide to a national issue and makes it crosscutting with government agencies and communities,” Dr. Miller said. “That is so important when you look at the rising suicide rates around in the nation.”

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