We should do something different and honor the vets who served us
Twenty service members and veterans a day are killing themselves and in ways that send us a message. In Texas veterans witnessed another veteran kill himself in a VA waiting room. Last month, three Navy sailors died, two by suicide and one from alcohol-related causes. This is a national epidemic with a solution that exists yet is not fully implemented.
That solution is evidence-based psychotherapies (EBPs), targeted treatment for a problem, based on scientific evidence that has been proven to work, as opposed to “talk therapy” in which you only focus on issues occurring during the past week. EBPs are often short term, as few as 10 sessions, or as little as 1-3 weeks. EBPs typically include assignments to complete outside of therapy.
Psychologist can’t always predict who will die by suicide, but psychologists know how to reduce the risk of suicide. EBPs reduce suicidal thoughts and related symptoms, however we are not doing enough to remove barriers to veterans receiving this treatment.
It is not acceptable for our loved ones to die from a preventable disease. With 1.4 million suicide attempts per year, the U.S. is facing a mental health crisis. Thirty percent of Veterans report having suicidal thoughts. Like many other issues, our country leads the pack, placing in the top 15 percent in the world in terms of rates of suicide.
The World Health Organization estimates that 35-50 percent of people with mental health issues may not be receiving treatment. Many Americans struggle to access EBPs. Even though EBPs effectively treat many mental illnesses.
In America, mental health is still not treated the same as physical health. We are still not comfortable talking about suicide. We like to think we are. We like to think our culture has changed with numerous campaigns fighting against stigma and promoting self-care. But we still have a long way to go.
Stigma is still one of the biggest barriers to people getting help. One of the most cited concerns by veterans is that if they seek mental health treatment they will lose their security clearance, impacting their current or future career. Stigma related to mental health and help-seeking is directly tied to actual help seeking behaviors. This is why as a culture we must educate to dispel myths and raise awareness about EBPs that are proven to work.
A large number of veterans diagnosed with post-traumatic stress disorder (PTSD), depression, or substance use do not receive treatment following a diagnosis. Even though PTSD is one of the most common illness for which veterans receive service-connected disability, on par with tinnitus, hearing loss, and joint issues.
And as many as one in three veterans struggle with depressive symptoms and almost 20 percent of veterans from recent deployments report depression. Not surprisingly, suicidal thoughts are closely tied to PTSD and depression. PTSD is a risk factor for suicidal thoughts. Veterans with PTSD are up to 4x more likely to have suicidal thoughts than veterans without PTSD.
The average veteran with PTSD receiving mental health care at a VA does not receive a full course of EBP. This is another complex issue with various explanations. There are access-related barriers (difficulty scheduling appointments, transportation to care, missing work) and stigma-related barriers (therapy won’t help, therapy isn’t effective).
Veterans report that getting mental health care at a VA may be burdensome and veterans have low confidence in the system. Many veterans report that one of the biggest barriers to mental health care is concerns that if the seek treatment it will harm their career. Other veterans fear that a diagnosis of a mental illness will make them ineligible to own a gun or that talking about their problems won’t help. Some of these barriers are very real and can be addressed. Others are myths that with education can be dispelled.
VA research has also shown that those with highest disparity of care are often ethnic and racial minority veterans (little to no research examines disparities for LGBTQ veterans). Veterans report that VA health care is often inadequate at addressing their issues and some veterans prefer not to receive mental health care at a VA which may be the only place they receive free services.
However, before you judge the VA too harshly, note that minimal research is being conducted at settings outside of the VA system, and thus this disparity of care may be occurring nationwide. In fact, the VA has actually been shown to be as good, if not better at providing mental health care for veterans. Moreover, the VA has fewer gaps in the use of effective treatments than the private sector and receives higher provider satisfaction.
For many reasons, veterans, especially those with PTSD, often do not seek treatment, refuse it, drop out, or do not receive evidence based care. This means that interventions need to specifically address these attitudes. I am aware that I am suggesting a counter-culture idea for veterans.
Veterans are taught to be strong, not show emotion, and definitely not be mentally “weak.” And yet veteran culture also preaches to leave no man (or woman) behind, and our country is leaving at least 6,000 veterans in the grave every year.
But good therapy and education targets these beliefs and challenges them. The military is also implementing campaigns, providing education, and trainings to address stigma-related beliefs.
Let’s be clear. Suicide is a growing national problem. To make matters worse, there is no single path that leads to suicide or single strategy to solve suicide. Suicide is complex and there is a lot we have yet to understand about it. But just because an issue is complex does not mean we should not fight to solve it.
I am a clinical psychologist at the Rush University Medical Center Road Home Program for veterans and their Families. We offer no-cost intensive treatment programs for veterans with PTSD utilizing EBPs. We use an EBP that targets beliefs, specifically, the cognitions that predict suicide. Our results speak for themselves. We achieve significant reductions both PTSD and depression and on average 92 percent of our veterans complete the intensive program.
Our program is unique, and we are lucky to have many resources. We do everything we can to reduce barriers: we educate, we provide treatment and transportation at no cost to the veterans, for veterans anywhere in the country. We offer these EBPs to veteran family members as well. Yet I believe the real reason our program works is because our clinicians care, we are skilled at what we do, and we provide well delivered EBP.
You can do a lot with a little, if it works. Some psychologist will tell you to ignore the science and that it will take almost a year in therapy to see improvements. I used to be skeptical myself. But EBPs have been proven to help individuals in low-income countries, torture survivors, individuals living in on going war torn Iraq, and the list goes on.
So, how about on this Veterans Day instead of saying “thank you for your service” which often feels like an empty platitude and annoys veterans: provide education, provide awareness and reduce stigma. We should also talk about evidence-based care for mental health. Tell a veteran with PTSD about a new road home. A Road Home that is effective and leads to change in 21 days. Help us honor all veterans by bringing them all home from the mental war they may still be fighting.
On this Veterans Day, we should do something different to honor the living who have served us. We should not only vow to reduce the 20 a day to as close to 0 as we can, we should implement changes to make this a reality.
Jennifer Coleman, Ph.D., is a clinical psychologist with the Road Home Program at Rush University Medical Center. She is a Public Voices Fellow with The OpEd Project.
Contact the Road Home Program. National suicide prevention lifeline 1-800-273-8255. Call the Veterans Crisis Line at 1-800-273-8255 and Press 1, send a text message to 838255, or chat online.
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