Veteran Suicides Are 'Public Health And National Security Crisis'

As the suicide rate among veterans in Ohio remains nearly twice that of the adult population — part of a national trend the White House last week called a public health crisis — local veteran Clarence Jennings has a message for other veterans: There is hope and help that works.

Jennings tried to kill himself twice before he wound up at the Dayton Veterans Affairs Medical Center and found help for his mental health and addiction issues.

“The hardest thing is taking that first step and letting somebody know you are having a problem. Don’t be ashamed. Reach out and let it out,” Jennings said. “There are support groups, mentor programs, peer support. We have a lot of staff here at the VA that’s willing to help you out, willing to listen. Don’t be afraid.”

Looking back, Jennings remembers his feelings of shame and embarrassment that his life had spiraled as it had: chained to drugs and alcohol, separated from his family and sometimes homeless.

“For me that was my bottom,” said Jennings, 65, of Dayton. “At that point I knew that if I didn’t go somewhere and do something, I wasn’t going to be here too much longer. That I was going to be gone.”

Jennings, a veteran of the Army and Navy, entered the Dayton VA’s dual diagnosis program in April 2009 and found his turning point. He’s been sober for 12 years, successfully manages his depression and works as a vocational rehab specialist at the VA.

In 2019, 6,261 U.S. veterans died by suicide, including 257 Ohioans, according to the most recent data available in the 2021 National Suicide Prevention Annual Report released in September by the U.S. Department of Veterans Affairs.

All adult suicides totaled 45,861 in the U.S., a rate of 18 per 100,000 people. The rate for veterans was 31.6 and for Ohio veterans it was 33.7, according to federal data. Firearms were by far the most common method of suicide.

“One suicide is one too many. We know we are able to be there and do what we can. But it is also that veteran that has the ultimate decision,” said Karon Wolfe, suicide prevention coordinator at the Dayton VA.

“It’s a very individualized situation. Usually not one actual component is the cause,” Wolfe said. “It’s a multifaceted cause that creates suicidality.”

Vet suicides exceed combat deaths

Reducing veteran and military suicides has been a government priority for several years. On Tuesday, President Joe Biden announced a comprehensive, cross-sector public health strategy for reducing those suicides, which the White House called “a public health and national security crisis.”

“Since 2010, more than 65,000 veterans have died by suicide — more than the total number of deaths from combat during the Vietnam War and the operations in Iraq and Afghanistan combined,” according to a fact sheet released by the Biden Administration.

Military suicides grew in 2020 during COVID pandemic.

On an average day 17 veterans and two service members die by suicide, Biden said in a statement released by the White House with his new prevention strategy.

“Each of these precious lives leaves behind loves ones who feel their absence every single day, like a black hole in the middle of their chests,” Biden said.

The new strategy focuses on:

• Improving safety around lethal means of suicide, including firearms and medications.
• Enhancing access to high-quality crisis care and after-care.
• Addressing issues that increase risk for suicide, like financial insecurity, unemployment, lack of housing and legal trouble.
• Increasing research coordination and data sharing, and doing more rigorous evaluation of prevention and treatment programs.

Progress has been made after the nation saw an average increase in veteran suicides of 48 in each year between 2005 and 2018, according to the annual report. In 2019 the number of veteran suicides decreased by 399 from the year before, the lowest total it had been since 2007.

“There are some anchors of hope that we’ve been seeing,” Wolfe said.

The VA offers an array of programs free to veterans to help with suicidal thoughts, mental health, substance abuse and life issues, Wolfe said.

That includes increased emphasis on access to care, either through the VA or through community providers, she said.

Not sure how to help prevent suicide? Free training can help.

The VA has expanded training and collaboration with community partners. And services are also being provided in new clinical hubs around the nation, including one in Cleveland that offers cognitive behavioral therapy to address suicidality, Wolfe said.

“Within the VA we’ve really started looking at what is evidence-based treatment, what is measurement-based care,” Wolfe said. “We are listening to the veteran: How are you feeling? Is this treatment effective? If it’s not, let’s try something else.”

Risk factors for suicide

Multiple risk factors exist for suicide, including a prior attempt, mental health issues, substance abuse, access to lethal means, loss of a loved one, homelessness, getting older, retiring and losing a sense of connectedness, said Wolfe.

She emphasized that those risk factors might not result in a person attempting suicide, and said it’s also important to consider what kind of protective factors are at work in the person’s life. Those would include access to care, ability to problem-solve through a crisis, having a mission or purpose, and having social and emotional well-being.

“What we know about suicide is it is a very complex problem for anyone,” Wolfe said. “So being able to look at their whole health, their socioeconomic (situation), their relationships, the whole person. All of that really does help to prevent suicide.”

Some veterans, along with law enforcement personnel and other first responders, might grapple with Post Traumatic Stress Disorder, said Marnie L. Masten, program director at Samaritan Behavioral Health CrisisCare in Dayton. The continuous exposure to death and human suffering can lead to a trauma response, like flashbacks or nightmares, she said.

“If they don’t seek some treatment or support as they encounter those symptoms, they can get into a pattern of pretty maladaptive functioning. They may have depressive symptoms, they may have anxiety symptoms if they’re suffering from a post traumatic stress response,” Masten said. “And then throw in some substance use issues, and you end up with this downward spiral.”

Peer support from others who have lived that experience can be a huge help “so when they are going through that they understand that the responses they are having are normal given what they’ve been exposed to,” she said.

People considering suicide often grapple with feelings of hopelessness about the future, Masten said. They might feel they have failed, they don’t have value and nothing is going to change, she said.

“Depression starts to set in,” she said. “(They think) things are never going to get any better and that’s when they start to go down a rabbit hole.”

Family and friends should watch for sudden changes in behavior, Wolfe said.

Other warning signs include pervasive feelings of sadness, noticeable mood changes, talk of life being better without them, increased substance use, missing work or school and loss of pleasure, Masten said.

“Usually that’s a big indicator: loss of pleasure in pleasurable activities,” she said. “Things that people usually like to do, they stop doing.”

How to help

Call for help immediately if a loved one is threatening suicide or attempting it. If necessary, get to safety yourself and make the call. The National Suicide Prevention Lifeline and Veterans Crisis Line use the same toll-free number, and calling 911 will get local law enforcement there quickly. Local police are trained in how to respond to a mental health crisis and a suicide prevention professional may accompany them, said Masten.

It might be necessary to apply for involuntary admission to a hospital, which the person attempting suicide may resist, but Wolfe said in most cases once the crisis has passed, the individual is glad to have gotten the help.

She said it is important to remove lethal items or to make them inaccessible to someone considering suicide. Her office is available for veterans or their loved ones to call to learn more about helping a struggling veteran.

Wolfe and Masten said it is critical to talk to the person about what they are feeling and what they need, and to help them feel less isolated.

“One of the biggest things is to let them know that they are not alone in what they’re going through,” Masten said. “Providers, family members, whoever is a supportive person in their life can really be a valuable asset during those times.”

Both applauded the increased openness toward talking about mental illness and suicide, which removes the stigma that may keep some people from seeking help.

For Jennings, learning to open up to people and talk about his issues, especially with other veterans, was critical to his recovery.

“I feel good about myself. I have good days. I have bad days. But overall I think the resources I have and the people I have in my support group, I can reach out to them. I don’t hold back anymore,” Jennings said.

“I learned that it is OK to be in a bad place. It’s OK to feel like I feel on those days. I can feel and I can share. Even if I go tell it to myself in the mirror, it’s always better than to hold it in. I released it.”

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Suicide warning signs:

• Considering or researching ways to hurt or kill yourself
• Talking about death, dying or suicide
• Self-destructive behavior, such as drug abuse
• Frequently sad or depressed
• Hopelessness
• Anxiety, agitation, sleeplessness or mood swings
• Feeling as if there is no reason to live
• Feeling excessive guilt, shame or sense of failure
• Rage or anger
• Engaging in risky activities
• Losing interest in hobbies, work or school
• Increasing alcohol or drug misuse
• Neglecting personal welfare and appearance
• Withdrawing from family and friends
• Showing violent behavior
• Giving away prized possessions
• Getting affairs in order or writing a will