When 2,977 Americans were killed on 9/11, we went to war. Yet, year after year, more than 6,000 Veterans die by suicide. Since 2006 we have lost more than 79,000 Veterans by suicide — a number that eclipses the 10-year American death toll in Vietnam. We give more money to the Department of Veterans Affairs (VA) for the same treatments, suggest that VA care is the best, and move on. But at no time has serious congressional diligence been undertaken to ask the tough question: Why isn’t this working?
Fewer than eight congressional staff focus on reducing this epidemic, plus a few more if you include staff from the Armed Services committees. Nearly all of these staff are dual-hatted, focused on providing oversight to the most extensive health care system in the world, with 1,074 outpatient sites, 170 VA medical centers and a budget request this year of $220.2 billion. Their attention has, for decades, been split on implementation of choice/mission, various medical emergencies, accountability of employees — the list goes on.
At no time has our Veterans’ suicide epidemic been a full-time priority for Congress. And, to be clear, the problem starts at the Department of Defense (DOD) and ends with the VA's National Cemetery Administration.
Confronting the reality that there is no easy solution is painful. For years, Congress has appropriated significant resources to the VA, with the VA’s mental health budget ballooning to a requested $9.4 billion in 2019. The total spent on existing approaches equals $67.1 billion since 2006.
The bulk of this funding has gone to treatment modalities that focus on talk therapy, cognitive processing therapy (CPT), prolonged exposure and psychotropics. The vast majority of the research has similarly focused on reinforcing these treatments.
It's not working, as the data and death toll show.
The day after Christmas, the VA delivered to Congress the “2018 Annual Report: VA Mental Health Program and Suicide Prevention Services Independent Evaluation.” The report was required by the Clay Hunt SAV Act of 2015, which was the last time Congress was intensely interested in this issue.
We shared the results with some noted psychologists. Here is their analysis of the data:
“Bottom-line Analysis for General Mental Health: The Report authors are reporting statistically significant changes, but in reality, there is little practical improvement for the Veterans. Overall, the changes are not large enough for the typical Veteran to report any noticeable improvement in their general mental health.
“Bottom-line Analysis for PTSD Speciality Care Services: The measures of clinical symptoms show no real improvement, and the Veterans report the same.”
There is another, more concerning report that seemingly never caught the attention of Congress. This seems to be the most definitive analysis with regard to the treatment modalities we continue to suggest are the “crown-jewels” of VA mental health. In the August 2015 “Journal of the American Medical Association” (JAMA), “Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials in JAMA” suggests that CPT and prolonged exposure help many. It highlights high dropout rates, and it emphasizes that two-thirds of patients retain their diagnosis of PTSD. The study states that "trauma-focused interventions show marginally superior results compared with active control conditions (those that did not receive the treatment).” And, probably most notable for Congress, the article highlights a need to find new treatments.
One of the biggest challenges Congress has faced in surmounting this issue is that it has divided it among the VA and Armed Services committees, with the primary responsibility landing squarely with the VA panel. The problem starts with DOD, if not before enlistment. Having a select committee of representatives with strong backgrounds from both the House Armed Services and House Veterans Affairs committees would allow Congress to view the issue from a holistic standpoint and work toward novel solutions.
Congress has shown cultural ineptitude by failing to view the issue from the Veteran’s standpoint. My fellow Veterans and I want to live great lives, be inspired, do great things, continue serving in a range of capacities. There is nothing particularly inspiring about a VA medical center. We need to stop treating Veterans as broken. Instead, we should ask Veterans what the solutions look like, versus asking the industries and unions that benefit from those solutions. We don't want to live diminished lives in hospitals, on medications.
We have handed far too much of this responsibility to VA — and failed to include DOD, our community, our peers and mentors as part of the solution.
In the end, the goal is and always should be: How do we find the best solutions to serve those who can and should be the most influential leaders in our nation: our Veterans?
Congress should create a Select Committee on Suicide and Mental Health and assign strong leadership from both the House Armed Services and House Veterans Affairs Committees, along with dedicated staff. Rep. Conor Lamb (D-Pa.), a Marine Veteran, would be a great member to hold the gavel; he supports novel approaches and supported a whole-health bill. Rep. Brian Mast (R-Fla.), an Army Veteran, would be a great addition; he has supported new methods of treatment and has overcome immense struggle — not only surviving but thriving following significant injuries in service to our nation.
Both of these congressmen understand our challenges, and both care for our Veterans immensely. They want it to work because, for them, it's about doing right by our Veterans, not about serving the status quo or playing politics.