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New law to assist in military suicide prevention

By VICTORIA ALDRICH | Kerrville Daily Times, Texas (Tribune News Service) | Published: March 3, 2015

If anyone understands the toll of war, it's Hill Country Mental Health and Developmental Disabilities Centers veterans services director Mike Cagle.

He sees the aftermath walk through the door every day.

Often it's a combat veteran coping with physical or emotional problems, substance abuse or homelessness. Some just need to chat or time to relax, he said.

Few issues are as devastating as traumatic brain injuries or post-traumatic stress disorder, a gamut of physiological and psychological conditions that, too often, ends in suicide.

"Most of these guys and gals are very young, some as young as 17 with their parents' permission, when they sign up," Cagle said. "They have a normal life, and they volunteer their services. After a combat tour, they aren't the same. They have seen things that most people won't see in their lifetime. They come back to a world where people don't understand what they have had to do to survive. Their families, on the other hand, think they should be just the same as when they left."

PTSD was a core issue in the trial of Marine Corps veteran Eddie Ray Routh, who was convicted Tuesday of shooting Chad Littlefield and former Navy SEAL Chris Kyle to death at an Erath County gun range in 2013.

To address the problem, President Barack Obama signed the Clay Hunt Suicide Prevention for American Veterans Act on
Feb. 12 to streamline and expand the Department of Veterans Affairs' mental health services. The law is named for Houston native Hunt, a Marine corporal who committed suicide in March 2011.

The bill is welcome news for Cagle, who also provides services as part of the Military Veteran Peer Network, which operates independently of the VA.

"I think it will complement what we are doing," Cagle said. "There are many suicide prevention programs out there, and the more we can get, the better. The programs we have now, they may not be accessible to everyone."

Three-year pilot programs will be created in at least five veterans integrated service networks nationwide to create a peer support network and a community outreach team for each medical center in that VISN, a move Cagle said will complement Kerrville's current peer network.

VA Secretary Robert McDonald also must collaborate with community nonprofit mental health agencies to develop and implement services for veterans, including exchanging training sessions and best practices.

"That is an excellent idea and will benefit everyone," Cagle said.

The VA also may select a director of suicide prevention coordination to oversee the efforts.

Military Veteran Peer Network veterans services coordinator Alan Hill thinks Texas has an excellent shot at participating in the program.

"The top three states for veterans, by population, are California, Texas and Florida," Hill said. "The top three states for veterans issues, including suicides, also are California, Texas and Florida."

The VA also must assess current Internet sites and create a comprehensive central website listing all mental health resources, updated at least quarterly.

A three-year pilot program will be created to repay up to $30,000 annually in school loans for licensed psychiatrists or psychiatric residents who pledge to work at least two years in the veterans' health care system.

To improve service and increase oversight, a yearly evaluation of the mental health care and suicide prevention programs by an outside source also is required. Combat veterans' eligibility for VA hospital care, medical services and nursing home care for illnesses not proven to have been caused by military service is extended through Jan. 1, 2016, for those discharged or released from active duty between Jan. 1, 2009, and Jan. 1, 2011. To be eligible, a person must not have been enrolled for care during the five-year period of eligibility following discharge.

As former law enforcement officers Cagle, Hill and wellness recovery action plan coordinator Walter Lee are pleased that lawmakers are now formally recognizing veterans' health issues instead of denying them, a policy Hill said prevented physicians from treating them and insurance companies from paying for care.

Augmenting peer networks is especially helpful, Cagle said, because veterans often won't discuss their experiences with family.

"Their mind-set, when they go into the military, it is drilled into them constantly, 'Suck it up, tough it up, get over it,' " Cagle said. "A lot of times, that's what they have to do, because they are in a situation where, regardless of how it's going to turn out, they  have to get things done, and it's a matter of life or death. They are in a constant state of 'red alert,' there is no downtime. We do our best to try to find and hire veterans who have actually experienced traumatic incidents, including combat veterans. Veterans often don't trust anybody but another veteran."

The Department of Defense's most current Suicide Event Report shows that in 2013, the last year statistics are available, the suicide rate for troops on active duty was 18.7 per 100,000 population. The 2012 rate was 22.7 per 100,000.

Rates for the services branches per 100,000 people were 23 for the Army, 23.1 for the Marine Corps, 14.4 for the Air Force and 13.4 for the Navy.

In comparison, the suicide rate amongst civilians of the same ages and socio-economic status is 18.8 per 100,000, according to Army and National Institutes of Mental Health.

Suicide victims typically were white, high school-educated, male enlistees 30 or younger. Those who attempted suicide typically were diagnosed with mood or anxiety disorders, and cited failed relationships or workplace and financial issues as stressors, the study found. Those who succeeded typically were diagnosed with mood or adjustment disorders and had experienced failed relationships or administrative/legal issues.

Hill and Cagle dispute those statistics, placing suicide attempts and completions at closer to 50 per day based on other reports and their own experiences.

Teaching a veteran and family member to recognize and cope with PTSD triggers is one of the most important steps, according to Lee, an Air Force veteran. No movie or television show can accurately depict battlefield experiences, Cagle said.

"Sometimes it's a smell, a sound or burning the hair on your arm lighting a barbecue pit -- and flash back to a bad sight," Lee said.

"Where someone is driving down the road and hears a backfire, the veteran driving down the road hears explosions," Cagle said. "Someone may see someone walking down the road in a hoodie and see a suicide bomber who is waiting for them to drive by."

Lee coped with substance abuse before his moment of clarity, experiences he puts to good use coordinating reintegration therapy.

"I was living on river banks six months at a time, testing out prototype bikes and race tires," Lee said. "I had a doctor put an advance directive in front of me, telling me, 'You are doing a good enough job trying to kill yourself without getting your son involved or screwing him up worse than you already have.' "

Lee completed a 90-day rehabilitation program before joining MHDD. Unlike other employers, the program is designed to allow employees and volunteers to take time off when stressors act up. Often that means getting away from people for outdoor recreation, a low-stress environment the center heavily incorporates into treatment.

"I want people out there to see that recovery is possible," Lee said. "Part of recovery is learning to move through grief resolution and embrace what you are going through and will be dealing with for the rest of your life."

(c)2015 the Kerrville Daily Times (Kerrville, Texas)
Visit the Kerrville Daily Times (Kerrville, Texas) at www.dailytimes.com
Distributed by Tribune Content Agency, LLC

A 2009 public service poster designed to raise awareness about stress-related causes of suicide amongst U.S. servicemembers. The Veterans Crisis line can be reached at 1-800-273-8255.
PHOTO ILLUSTRATION BY COREY HOOK/U.S. AIR FORCE

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