Keita Franklin is the former senior executive director for the Office of Mental Health and Suicide Prevention at the U.S. Department of Veterans Affairs and senior executive for the Defense Suicide Prevention Program for the U.S. Department of Defense. She is an executive at Deloitte Consulting LLP.
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Loved ones who have lost a service member or veteran to suicide have a shared agony.
The heartache of losing a child is immeasurable, but I recall one mother, a nurse, who also couldn't enter a hospital anymore without suffering a panic attack. She felt helpless in a role where she was responsible for helping others.
Her son took his life on Mother's Day, 2,000 miles away from their family home. The young soldier, in his early 20s, was experiencing a humiliating breakup, had been injured and had seen the terrors of war. Prescription medicine managed his physical pain, though he may have misused it to numb his feelings. He felt marginalized within his command -- like he didn't fit in and was unsure about the future.
Loved ones who are left to deal with the aftermath of suicide often wonder how to pick up the pieces and move forward with their lives. Many blame themselves, often feeling like they missed something or didn't see the signs.
But just like the risks for suicide are many, so are the methods for preventing it. Each veteran is unique, and their experiences are their own. This means that a wide array of interventions are needed to respond to the risks.
Over the last decade, the U.S. Department of Veterans Affairs has made strides to reduce veterans' suicides. The agency's 2022 National Veteran Suicide Prevention Annual Report revealed that age- and sex-adjusted suicide rates for veterans fell by 9.7% from 2018 to 2020.
Despite these promising findings, there continue to be sub-populations of veterans who are difficult to reach, including female veterans, veterans who live in rural areas, Native American veterans, LGBT+ veterans and those who have recently transitioned out of military service. The Department of Defense also experienced a gradual increase in suicides among full-time service members from 2011 to 2021, according to its annual suicide report.
These seemingly contradictory findings should not discourage us from examining what we have done right in the fight against suicide. In fact, we should shine a spotlight on what is working.
For one thing, the VA has reconceptualized how it approaches suicide prevention itself.
In decades past, mental health professionals relied on a "medical model" of care for those in crisis; we focused our efforts treating suicide risk once it became known to us within the confines of a health system. To overcome the many shortcomings of this model, the VA transitioned to a public health approach that emphasizes the important role of people who interact with someone experiencing suicidal ideation -- like supervisors, spouses, friends and colleagues -- and involves a host of non-medical public health interventions. This instrumental change recognized the simple proposition that suicide is not just a medical issue, but a whole-of-life challenge for our society where many of us must play a role.
The VA also strongly advocated for a streamlined approach to 988, the new, three-digit hotline for crisis care. The number provides access to a strengthened network of crisis call centers, including the Veterans Crisis Line. Similarly, the VA has been an early adopter of hiring peer support staff -- veterans who have "been there" -- and incorporating them into the overall delivery of care.
Additionally, the VA and the DoD have come together to increase proactive mental health attention during high-risk periods, like crisis events or when a service member transitions out of the military. Digging deep into these high-risk areas is essential, and likely helped lead to the recent reductions of suicide in some populations. Of the 303 recorded suicides of active service members in 2021, 46% had a reported behavioral health diagnosis. Trauma- or stressor-related diagnoses comprised the largest part of these at 26%, according to the DoD annual report.
But what else can be done as we move into 2023 and beyond? Here are three necessary actions moving forward.
First, we need to increase innovation and active collaboration between the private sector, nonprofits and government.
Suicide prevention strategies should, at a minimum, keep pace with technology advancements. Complexities surrounding the impacts of social media and online gaming, as well as understanding how young people connect with handheld devices and networked communities, require a consistent and sustained push toward creative prevention, intervention and treatment models.
Government systems often struggle with swift innovation when it's done in a silo -- one of the many reasons why collaboration with the private sector should be bolstered. Telehealth is good. The use of apps to regulate breathing is helpful. But developing a strategic path to embrace additional innovative techniques at a faster pace can actually save lives.
Second, we should continue to pursue more unified approaches. Sexual assault, domestic violence, homelessness, opioid addiction and unemployment are all complex problems that often co-exist with mental health challenges, including suicidal ideation.
Developing a plan that includes holistic approaches is essential. We're talking about more than standing up a new office or co-locating programs; while helpful, they're not enough.
We should pull together and fund the myriad programs that target common risks and protective factors, and ensure collective and integrated prevention focused actions. Imagine the power of reducing multiple high-risk issues with the same program or effort.
Finally, we should use data and deep analytics across all of government and even the private sector where appropriate or necessary to better understand the root causes of suicide so we can reduce the risk. This data-informed approach would better prevention efforts.
The DoD and VA have several targeted data elements -- from personnel and health records -- that inform suicide prevention. The two agencies continue to have a lot to learn from each other to correlate potential patterns. Taking this effort a step further, data from Medicare, Medicaid, the Labor Department, Social Security, state law enforcement, and other private-sector entities could contribute to a more broad-based understanding of suicide risk, not only for service members and veterans, but for all Americans.
