By Sabina Mollot
From January 22-25, the Department of Veterans Affairs (VA) has been engaging in a nationwide suicide prevention effort, with the various facilities, including Manhattan VA on East 23rd Street, hoping to reach out to veterans who wouldn’t normally show up at their doors.
This is because 20 veterans die by suicide each day and out of those 20, 14 haven’t been seeking services at the VA.
Meanwhile, the VA has developed the most comprehensive suicide prevention program in the entire country, according to suicide prevention coordinator Kate Mostkoff and Mia Ihm, PhD, a clinical psychologist, who both work at the Manhattan hospital. A VA system-wide veterans crisis line gets hundreds of calls each day, with on average two or three of those calls being routed to the Manhattan VA on weekdays, and even more on weekends. This makes the Manhattan campus one of the busier recipients of such calls and the hospital is required to respond to those calls within 24 hours. The line, staffed by veterans and family members, can be reached at 1-800-273-8255 (Press 1).
When responding to callers, it’s usually recommended that the caller follow up to determine if the problem is PTSD related. “Sometimes a hospital stay is required,” said Mostkoff, “usually brief” at a mental health outpatient clinic for common problems such as substance abuse, anxiety or depression.
While most veteran suicides are by individuals over 50, suicide by young veterans between 18 and 34 as well as women is on the rise. But getting women and younger men to turn to the VA for their care has been a challenge for the agency.
“When you walk in the lobby, what do you see? Older men,” noted Mostkoff. “That can be a barrier even for younger men.”
One recent step to change this was opening clinics at the Manhattan VA that are for women only and women only time slots at the clubhouse on Thursdays, which have been well-utilized.
The hospital has also opened a clinic for Post Traumatic Stress Disorder (PTSD), which Ihm said has been a success due to its allowing individuals to make their own decisions on the kind of treatments to partake in. In Manhattan, the VA is a training hospital for New York University with an emphasis on suicide prevention and outreach teams have also been stationed on college campuses.
What the VA has found is that suicidal thoughts are just as common over stress from a family or employment situation as they are about the lingering effects of multiple combat tours. Employment in particular is a struggle in the veteran community.
“There are people who consider a veteran an asset and people who think of a veteran as a liability,” said Ihm. “People have so many preconceptions that all veterans must have some kind of trauma.” But, she added, “Most veterans do not have PTSD.” She put the figure at around 20 percent.
That said, those with military training tend to be well-versed in the art of keeping quiet about their complaints. The VA recommends that friends, family members and colleagues of veterans they think may be in crisis look for any changes in the person’s overall behavior.
Signs can include seeming depressed, anxious, talking or writing about death or feeling overwhelmed, trapped or hopeless as well as an increase in substance abuse. Other signs could be changes in spiritual behavior, such as “suddenly becoming hyper-religious or a feeling that they’ve lost their beliefs,” said Ihm.
Ihm recommends asking about the veteran’s experiences, including what it was like getting drafted or enlisted.
“If the veteran doesn’t want to talk about it, if you express concern, understand that civilians don’t know but we can try to understand,” she said.
It may be helpful, too, to come right out and ask if the person has been feeling suicidal, considering that in the majority of suicides, the person has disclosed their thoughts to someone else first. In 90 percent of those cases, the person has a psychiatric illness. And friends and family should be prepared to hear that the person has no interest in seeking treatment.
Mostkoff said, “They’ll say, ‘I’ve been to rehab 10 times,’ but sometimes it takes that eleventh go-around in rehab.” The opioid crisis has hit veterans as hard as anyone else, but all VA centers have opioid treatments available, including Naloxone overdose medication kits.
Seventy percent of veteran suicides, however, happen with the aid of a gun.
“It’s a lethal combination of training and familiarity,” said Mostkoff, so veterans who’ve spoken about suicide are encouraged to put locks on their guns (which the VA keeps on hand to give away) or turn the guns over to law enforcement. Generally, they’re cooperative about doing so, she said.
The best thing to do if concerned about a veteran is to have him or her call the veteran crisis line, said Mostkoff, because while there are numerous services available to help veterans, if someone is at risk, it isn’t realistic to expect the person to be up for researching their options.
“When they call the crisis line, they come in and we can take care of you from there,” she said.
Despite suicide being a national crisis, New York State actually has one of the lowest suicide rates in the country, which Ihm said is due to a number of factors like easier access to care than in rural areas and less isolation.
In order to be eligible for services at a VA facility, a veteran would have to have served at least two years in a military branch with an honorable discharge. Any questions about eligibility can be addressed at the eligibility office, which is located in the hospital lobby, as long as the veteran has discharge papers on hand.