How Can Veteran Suicides Be Prevented?

Veteran suicides are a major concern and have been on the rise in the United States. Why

are veterans committing suicide and how can they be prevented? Veterans experience trauma

while serving and this trauma turns into Post Traumatic Stress Disorder and other mental health

issues. Is their Post-Traumatic Stress disorder being addressed and treated by experienced

medical professionals? The mental health of veterans needs to be a top concern so that veteran

suicides can be prevented.

In the 14 years from 2003 to 2017, combat operations in Iraq accounted for 4,410

fatalities; in 2014 alone, more than 7,300 veterans took their own life (Faucett, 2021). Veterans

are at a much higher risk for suicide than civilians. They are over twenty percent likelier to kill

themselves than civilians (Faucett, 2021). Over the years, there has been many issues with the

medical care from the VA for active-duty military and veterans. There are month long waits to

get into a specialty doctor and many veterans cannot wait months for medical care. Since the

start of the Veteran’s Affairs in 1921, it has grown exponentially, and its growth has contributed

to its long wait times to get in to see a doctor. The VA is also not equipped to handle the

complexity of the mental health concerns of a veteran. Not only do they not have enough

physicians; they do not have enough that specialize in treating trauma related to combat and Post

Traumatic Stress Disorder. Veteran suicides are getting more and more attention in the recent

years and different organizations are emerging with prevention plans. The VA has slowly started

support groups for veterans. These support groups are run by veterans, which is the most

effective way. Vet-to-vet always has the best results and better feedback. This is because

veterans often feel alone in their thoughts. They desire connections with people who know what

they have been through and who are struggling with the same battles.
 Suicide rates have drastically increased 33% from 1999 to 2017 (Steinhauer, 2019).

Veteran suicides have largely contributed to this increase. In 2014, 7,300 veterans committed

suicide (Faucett, 2021). Veterans make up 7.9% of the population for adults but make up 13.5%

of suicides in the United States (Faucett, 2021). This is an alarming percentage. Why are so

many veterans committing suicide? What sets them apart from civilians going through similar

mental health issues? Why are they feeling like they cannot get the help they need? Healthcare

from the Veteran’s Affairs hospital is a major concern. There are long wait times to get any kind

of appointment with a doctor. A local Dayton area veteran explained that he goes to the VA

hospital for his medical care. He had injured himself accidentally one day and saw his primary

care physician located at the VA. After seeing his primary care doctor, he was referred to a

specialist. When calling the specialist, he was told that the soonest appointment they could get

him in for was in four weeks. So, he is having to endure this crippling pain from an injury and is

unable to hardly walk or work, even. He is now in a stressful predicament. He must wait a month

to probably just get a bare minimum assessment during a consultation with a specialist. Then, he

must wait even longer for an actual treatment plan and any medical imaging and test results to

come back and get analyzed. To make matters worse, his work was not happy with him for not

being able to work because of his injury and long wait time to get in to see a specialist. This now

puts a strain on his body, his job, finances, family, and mental health. It is no wonder that

veterans in a mental health crisis, or even dealing with an injury like this local veteran did,

cannot wait months to get into therapy or receive medical care.

Knowing the warning signs of suicide is an important key in prevention. There are at

least twenty veterans a day who commit suicide (Lifeline for Vets, 2021). A lot of times, a
veteran will show zero signs of being suicidal. This exact reason is why it is even more important

to understand who is at higher risk for suicide. Some veterans might appear to be depressed,

anxious, lack of confidence, or hopeless (Veteran Affairs, 2021). Veterans who suffered a

Traumatic Brain Injury while in the service are at a higher risk for Post-Traumatic Stress

Disorder, depression, and suicide. With the rise of veteran suicides, the Veteran’s Affairs suicide

prevention efforts have doubled. Because of the MISSION Act and AAC’s Salute to Recovery

program, urgently needed health care providers are more available to veterans (American

Addiction Centers, 2020). More organizations are arising in efforts to prevent veteran suicides.

Lifeline for Vets is one organization that aims in offering crisis care to veterans. This

organization is a lifeline for veterans in crisis. This organization sits apart from all the rest

because this is a veterans-to-veterans program. Veterans that call in get to talk to a fellow

veteran. This vet-to-vet model is a lot more successful when compared to other programs that do

not use this model (Lifeline for Vets, 2021).

More specifically, we lose twenty to twenty-five veterans a day to suicide (Lifeline for

Vets, 2021). Sixty-five percent of these suicides are veterans over the age of fifty (Faucett,

2021). The Veteran’s Affairs also found several risk factors that increase the risk of suicide of

veterans. It is vital for family and friends of veterans to be aware of these risk factors so that we

all can do our part in trying to prevent and stop a veteran from committing suicide. Being aware

of a risk factor could potentially come down to life or death of a veteran in some instances. If a

family or friend does not know that a close veteran has multiple risk factors that puts them at a

higher risk for suicide, then they may not know to watch out for the signs of suicide, if there are

any. Some of these risk factors are acute psychological stressors, low cholesterol, take opioids

for pain, trouble sleeping, anxiety, manic-depressive disorder, PTSD, TBI, and abusing
substances, specifically heavy drinking (American Addiction Centers, 2021). It is important for

health care professionals to also understand and be aware of the risk factors that contribute to

veteran suicide so that they know who is at a higher risk for suicide and treat them accordingly.

Veterans who deal with more than one of these factors are at an even higher risk for suicide.

Veteran suicide is also highly linked to substance abuse.

According to an article written by the American Addiction Centers, over three-quarters of

these veterans that commit suicide are not under care the Veteran’s Affairs (American Addiction

Centers, 2021). After a suicide attempt, veterans that receive a follow up mental health care

outreach are drastically less likely to show suicidal ideation. Nine emergency rooms were

studied, and it was concluded that veterans who previously attempted suicide but received an

outreach of some kind were forty-five percent less likely to exhibit suicidal behavior (Steinhauer,

2019). Upon returning from Iraq and Afghanistan, over half of veterans are diagnosed with some

kind of mental health disorder (American Addiction Centers, 2021). Over half of veterans who

are deployed come back with mental health issues, but three quarters of veterans are not under

the VA’s care. That is a big problem. Why aren’t veterans seeking out care from the Veteran’s

Affairs Medical Center? The wait times to get into a provider at the VA are too long and

unrealistic. The Veteran’s Affairs also have not had the resources to care for veterans seeking out

extensive mental health care for the TBI or PTSD. The VA is starting to make small positive

steps towards all-inclusive veteran care. The VA has started to do warm handoffs when referring

a veteran to another provider or specialty provider. Instead of handing the veteran a phone

number, they are introduced to the new health care provider and a consultation is performed with

future appointments scheduled. It is especially important to not leave a veteran hanging. If future
appointments are scheduled, then the veteran has an appointment to look forward to and it keeps

them coming back.

In preventing veteran suicide, it is important to understand the signs of suicidal behavior.

It is important for families, friends, and health care providers recognize signs of suicidal

behavior. These are different than the risk factors. Some more warning signs are depression,

anxiety, irritation, trouble sleeping or sleeping too much, not caring about looks, isolating from

family, friends, and society, loss of interest in things, expressing excessive guilt or feelings of

lack of purpose, acting violently, or taking extreme risks, deficient performance at work or

school, or doing things to prepare for suicide or harm (Veteran Affairs, 2021). The Veteran’s

Affairs also lists resources for family and friends of veterans that are seeking out ways to help

the veteran adjust and ways to just be there for them. They offer live coaches that family

members and friends of veterans can speak with to get advice on how to show their support.

Guns are used in most all veteran suicides. This is due to a high percentage of veterans

owning guns. Eighty percent of veteran suicides in Montana one year were carried out with guns

(Steinhauer, 2019). Reducing access to guns of veterans with mental health disorders would

significantly cause a drop in veteran suicides. Lawmakers are met with resistance though when

trying to pass legislation to reduce access to guns of veterans struggling with mental health

issues. Some states have emergency protection orders where law enforcement or family and

friends can remove a gun from an unstable veteran showing suicidal behavior.

The previous White House administration initiated a road map to the prevention of

military troops and veteran suicides. Swift action was taken since veteran suicides had been

raising at an alarming rate. A veteran suicide prevention campaign was started. Its main focus is

on involving community partners and putting a public awareness campaign in motion (All
Things Considered, 2020). Critics do not think this road map is aggressive enough. The public

awareness campaign did talk about a very taboo subject: veterans and their access to guns. This

is a very touchy subject because veterans know how to use guns. They served our country and

risked their lives all while using guns and now there is talk about taking them away from some

veterans? This subject does not go over well with most veterans. A way to look after a vet while

they are in a crisis is check to see if their gun is put away in a safe place away from them (All

Things Considered, 2020). It is offensive and strips their freedoms away. The root causes of

veteran suicides need addressed and preventitive measures focused on instead of stripping rights

prematurely. In extreme cases though, it might be necessary on a case-by-case basis. The

previous administrations plan to prevent veteran suicides focused on safe gun storage more than

taking guns away. Without talking about gun control, the Veteran’s Affairs started doing their

part in the prevention of veteran suicides. The VA handed out trigger locks to veterans waiting in

waiting rooms. There is no study to prove if trigger locks help but they must tread lightly when it

comes to talking about veterans and their firearms. This prevention campaign also focused on

getting veterans to put and keep their guns in a safe spot out of their reach when they are in

crisis. If a veteran wanted to end their life and use their gun to do it, the idea of putting their guns

away in a safe spot out of reach seems unrealistic. The veteran would already be in crisis and not

thinking clearly. How are they supposed to think clearly when it comes to making sure their gun

is put up somewhere away from them when in crisis? Not going to happen. Director of the

Veteran’s Affairs suicide prevention, Matt Miller, said, “The path from suicidal ideation to

action the majority of times occurs within 60 minutes or less so if that firearm, if it's near you,

that path can be engaged very quickly” (All Things Considered). Some gun rights activists are

willing to support the idea of safely storing a handgun during a crisis or giving the gun case keys
to someone else until they are needed, and they are not in a crisis. It is about finding a balance

between the two approaches and still being effective. A veteran is not going to listen to a medical

professional talking about the proper use of firearms and how to safely store them. A veteran

would be likely to listen to someone talking about gun safety who also advocates for the same

things they do, like guns and our second amendment right. Going back to the vet-to-vet

approach, this is not exactly the same as that approach but similar in the way that finding

common ground with someone who is trying to help you produces better results and makes

people more receptive if they share something with one another.

More organizations are creating programs that focus on veterans to aid in the prevention

of suicides. The organization American Addiction Centers has created treatment programs

especially for veterans. A program that they offer for veterans is the Salute to Recovery program.

This program is offered at two of their locations: Dessert Hope and Recovery First. This program

supports various addiction treatments and lessons dedicated to military veterans with substance

abuse issues and mental health problems (American Addiction Centers, 2021). This extensive

program covers nearly all of the bases. In its treatment program, they offer trauma groups,

relapse prevention, emotion regulation, grief and loss, spirituality, art therapy, 12-Step, cognitive

behavioral therapy, dialectical behavioral therapy, motivational interviewing, cognitive

processing therapy, EMDR, music therapy, nutrition, pain management, exercise, yoga, coping

skills, and recreational therapy. The backbone to the Salute to Recovery program is the First

Responder and Military Lifeline curriculum that was created in collaboration with The Veteran’s

Administration and Employment Assistance Professionals (American Addiction Centers, 2021).

The program is dedicated to veterans and military members whose lives have become

unmanageable and are struggling with reintegration. One quote from a veteran who completed
this program was: “The best aspect of the program for me was the ability of a guarded individual

to open up in a group of fellow veterans.” This follows the veteran-to-veteran approach. More

organizations need to follow in the footsteps of the American Addiction Centers and Lifeline for

Vets. This Vet-to-Vet model is profoundly more effective than other programs in helping

Veterans in crisis get the right care and get them back on their way to a successful reintegration

back to civilian life (Lifeline for Vets, 2021). Each VA has a suicide prevention coordinator who

veterans can contact and connect with so that they can be directed to the services and counseling

they need. In the recent years, the VA has rolled out training called the S.A.V.E. Training.

Training will help you act with care and compassion if you encounter a veteran who is in crisis

or experiencing suicidal thoughts (Veteran’s Affairs, 2021). The acronym S.A.V.E. has an

important meaning. According to the VA’s suicide prevention website, the “S” stands for Signs

of Suicidal Thinking Should be Recognized. They recommend people learn to recognize the

warning signs. A few of the warning signs listed are hopelessness, withdrawing from family and

friends, rage, anger, risky behavior, and increase in substance or alcohol use. This is exactly the

type of training we need everywhere so that we can make a difference in the number of veterans

that are taking their lives. Immediate warning signs are talk of death or dying, expressing they

want to hurt themselves; they are looking for way to kill themselves, and they have self-

destructive behavior (Veteran’s Affairs, 2021). The “A” stands for Ask the Most Important

Question of All-Are you thinking about killing yourself. The VA’s suicide prevention site gives

tips on how to ask this question effectively and without further upsetting the veteran in crisis.

The “V” stands for Validate the Veteran’s Experience. Validating the veteran’s experience can

just mean not to pass judgement on them and reassure them that there is help out there

specifically for veterans. Lastly, the “E” stands for Encourage Treatment and Expedite Help. The
last step is important. Do not leave the suicidal veteran alone and call 911 if necessary. Do not be

afraid to tell friends and family about their suicidal behavior. This is amazing training that every

veteran program and organization needs to have. The more places that offer this type of training,

the more people will take the training and remember the acronym and warning signs. These

simple steps could help save a veteran’s life. This is one of the key ways in bringing down the 22

veteran suicides a day.

A study was done on veteran suicides and the study concluded that even if the veteran was

getting good mental health treatment through the VA, suicide rates were not dropping. This was

in 2015. Because suicide rates were not dropping despite the results regarding mental health care,

the VA invited 7 cities to participate in the Mayor Challenge. The goal of the Mayor’s Challenge

is to eliminate suicide by using a comprehensive public health approach to suicide prevention

(Steinerhauer, 2019). The seven cities were chosen by the population of veterans within the city

and also the prevalence of suicide with

in the city. The VA will support collaborative teams in each city who will go out and brainstorm

an action plan for each of their communities. The people that make up these groups are people

who are part of the community within that specific city along with municipal and military people

as well.

A recap of some fundamental ideas on how to prevent veteran suicides start with

understanding the research on the veteran suicides and adjust according to the outcomes. In

2015, the VA realized, from a study, that even though veterans were getting decent mental health

care, the number of veteran suicides was not going down. They took this data and created the

Mayor Challenge. The VA targeted specific cities where veterans lived and where suicides were

high. Being aware of the risk factors and signs as discussed, several times are such a crucial

factor to preventing veteran suicide. If the people closest to veterans can recognize that they are

in crisis, then the numbers may start to fall. Are they a veteran over the age of fifty? Do they

have any other health conditions? Another way to help prevent veteran suicides would be to

implement the VA’s S.A.V.E. training in all veteran organizations and make it available to

anyone. Health care providers should have to go through training on this as well. Another way to

help prevent veteran suicide is to start with the VA. The VA needs shorter wait times to see

health care providers. Many cannot wait months or even weeks. They need to expand if they are

over capacity. More research is needed on veteran suicide so that effective ways of prevention

and treatment can be implemented. This requires funding and advocacy. The National Veterans

Foundation raises money to help Lifeline for Vets grow to accommodate more veterans. This is

why funding and donations are important to the survival of these programs, organizations, and

trainings. Anyone can make a donation to Lifeline for Vets. This allows them to keep operating

and so that they can grow their organizations to help more veterans. Reaching more veterans will
only help bring the suicide number down. Veteran suicide is a noticeably big issue right now and

everyone should do their part to help save the veterans who fought for our country and our rights.

This is not an issue that can wait. We are losing hundreds of veterans a week and these lives lost

might have been prevented with some sort of intervention and awareness.

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Nurse Practitioners, vol. 17, no. 5, May 2021, pp. 579–581. EBSCOhost,

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Steinerhauer, Jennifer. “V.A. Officials, and the Nation, Battle an Unrelenting Tide of Veteran

Suicide.” NYTimes.com, The New York Times, 14 August 2019,

https://www.nytimes.com/2019/04/14/us/politics/veterans-suicide.html. Accessed 24 July

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“Veteran Suicide Prevention.” Veterans Affairs, www.va.gov/health-care/health-needs-

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