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In 2010, the United States Department of Veteran Affairs began an intensive effort to shorten delays associated with access to the National Death Index (NDI) data. The motive is to increase understanding of suicide among all Veterans by developing data-sharing agreements with all 50 U.S. states. In 2012, the Department of Veterans Affairs (VA) conducted a study stating that an estimated twenty-two veterans commit suicide per day. Nonetheless, twenty-two per day is not a legitimate representation of the number of veterans that commit suicide per day. Unfortunately, the reality is that this numeral should be extensively higher. This paper will present a framework of the reality in which this statistic is extensively higher. In addition, this paper will explore the multiple discrepancies regarding the lack of thoroughly analyzed data from primary and highly populated states, and issues with veteran identification on death certificates. Thus, the paper will also provide the applicable theory possibly utilized in understanding veteran suicides as well as some of the possible strategies used in the intervention plans for veteran suicidal cases.
Suicide is an overlooked public health problem; it does not discriminate plaguing our nation, generating devastating effects on individuals, families, and communities. It is a taunting epidemic resulting in a trail of unanswered questions while loved ones grieve. According to the American Foundation for Suicide Prevention, in the United States alone, suicide is ‘the tenth leading cause of death,’ and 2017, ‘47,173 Americans are dying of suicide’ in 2017 (Suicide Statistics, 2019). The Centers for Disease Control and Prevention (CDC) data released in an April 2016 report indicated that between 1999 and 2014, suicide rates increased among the general population, for both men and women and all ages. While this is a striking statistic, it is needless to say, that it is unfortunate that this epidemic severely impacts the veteran community. In 2007, the United States Department of Veterans Affairs (VA) began an intensive effort to reduce suicide among Veterans. Influencing the Mental Health staffing expansion and the Joshua Omvig Bill, it included both attention to Veterans in crisis as well as those determined to be at high risk for suicide. A 2012 study conducted by the United States Department of Veterans Affairs, discovered that an estimated ‘twenty-two veterans die from suicide each day’ (Kemp & Bossarte, 2012).
In contrast, this statistic does not represent the actual mass of veterans that commit suicide each day. This paper will provide varying discrepancies; for instance, the suicide rate statistics reflect the data on the death certificates from twenty-one states. In addition, the issues with the veteran registration status, which impact death certificates, and most importantly, the misrepresentation of several significant veteran populations.
The VA’s study of twenty-two suicide per day study limitations stems from data from the ‘population of residents in twenty-one states, and it represents about 40% of the U.S. population’ (Basu, 2014). The twenty-one states reflect, ‘147,763 suicides reported, 27,062 (18.3%) (Kemp &Bossarte, 2012). Furthermore, ‘more than 34,000 suicides from the twenty-one states,’ reports data remained overlooked because the state death records failed to indicate whether the deceased was a veteran (Basu, 2013). The VA stated, ‘without linking to VA or DoD resources to validate the history of U.S. military service, it is necessary to remove those without information on the history of military service from estimates of Veteran status among suicide decedents’ (Kemp & Bossarte,
2012). Indeed, the statistics provide are vividly incorrect due to the lack of data regarding veteran suicides from approximately thirty other states. A major limitation of research excludes major states, such as California and Texas, with larger Veteran populations. The VA stated, ‘information from these states has been received and will be included in future reports’ (Kemp & Bossarte, 2012). For instance, the exclusion of these major states eliminates vital data on the vast amounts of veteran suicides. Neglecting data with the largest veteran populations skews data. Needless to say, death records in significant states such as California, Texas, Georgia, Arizona, and North Carolina (Lee, 2015). Another disregarded factor is the state of Montana, which has the highest suicide rate in the country with ‘25.9 suicides per 100,000 people’ (Alltucker & Price, 2018). It is imperative to include all state statistics because, in reality, suicide within the veteran population is gruesomely escalating.
Unfortunately, there is no all-inclusive method to identify veterans on death certificates accurately in reflecting the statement of twenty-two veterans commit suicide a day utilized as a representation of this dreadful epidemic. In the VA study, veteran status was only identified by a single question asking about the history of U.S. military service and currently, information about the history of military service is routinely obtained from family members and collected by funeral home staff and have not been validated using information from the Department of Defense or Veteran Affairs (Kemp & Bossarte, 2012). This example amplifies how this system is inaccurate, and it creates the misidentification of veteran status. In addition, it is vital to report that a family has a choice to disclose whether their love was a veteran. Lamentably, this is an actuality that severely impacts the data regarding the alarming suicide rates.
Additionally, neglected data is, if a veteran intentionally crashes a car or dies of a drug overdose and leaves no note, that death may not be counted as suicide (Basu, 2013). It is unfortunate because utilizing this system excludes veterans experiencing traumatic events. For example, in January 2018, an estimated 37,800 veterans were experiencing homelessness (U.S. Department of Veterans Affairs, 2019). Indeed, for veterans experiencing homelessness and having no connection within their families and he/she commits suicide, therefore, if the veteran who is homeless were to commit suicide, sadly, their departure is not included in the prevalent statistics. Hence, the twenty-two veterans a day statistic is not a valid representation of the high number of suicides committed by veterans.
Furthermore, this statistic excludes underrepresented veteran populations. For instance, individuals who received less-than-honorable discharge are not entitled to many, if any, veteran benefits and under the law, are not technically considered veterans. It is essential to note that up until September 2011, under the do not ask, do not tell policy, openly gay men, lesbians, and bisexuals were excluded from military service (Bumiller, 2011). Sadly, under this policy, if a service member were to disclose their sexual orientation, they were discharged. Although this circumstance may be appealed, a service member must produce documentation from their service which may be decades old, and often need a lawyer to get through the process (Ismay, 2016). It is discomforting because, a 2012 study, stated, Sexual minority veterans had significantly less social and emotional support and higher rates of suicidal ideation and attempts than heterosexual veterans (Blosnich, Bossarte, & Silenzio, 2012). Thus, the LGBTTQQIAAP (lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, asexual, ally, pansexual) veterans community that commits suicide is excluded from the VA study due to the lack of identification or affiliation as a veteran.
Another critical limitation within the VA study indicates that female veterans and younger-aged veterans had more prominent identification challenges in the study. The VA study directly stated, only 67% of true female veterans were identified and that younger or unmarried veterans and those with lower levels of education were also more likely to be missed on the death certificate (Kemp & Bossarte, 2012). This case serves as a significant limitation into consideration the spike in suicides among veterans between eighteen and twenty-four years old (Lee, 2015). This increases suicides for Post-9/11 veterans steadily increased from 2006 to 2016, with a jump of more than 10 percent from 2015 to 2016 (Shane, 2018). Therefore, in particular, post-9/11 veterans are less likely than pre-9/11 veterans to seek treatment for physical or psychological issues, with 36.8%. Research has shown that veterans are 22% more likely to commit suicide than non-veteran adults (VA, 2017). In addition, suicide attempt rates at 33.3% have made a plan to die by suicide (Castro, Kintzle, & Hassan, 2014). Underrepresenting these specific populations and not recognizing these circumstances, the twenty-two-a-day statistic is an invalid representation of the number of veterans that commit suicide per day.
In August 2012, former President Barack Obama, signed an executive order calling for stronger suicide prevention efforts, and in 2013, announced $107 million in new funding for better mental health treatment for veterans with post-traumatic stress and traumatic brain injury (Basu, 2014). This example is an adequate representation of providing the applicable theories utilized in understanding veteran suicides as well as some of the possible strategies used in the intervention plans for veteran suicidal cases. Moreover, in 2015, one of the most important veteran suicide prevention legislation was enacted. The Clay Hunt Suicide Prevention for American Veterans Act was named in honor of twenty-eight-year-old, Clay Hunt, a Marine veteran who died due to suicide in March of 2011. The act was designed to expand suicide prevention programs at the U.S. Department of Veterans Affairs through increased access to mental health services, community outreach, the development of a one-stop website, the requirement of collaboration between the VA and non-profit mental health organization, increased recruitment of additional psychiatric counselors, along with the requirement of annual evaluations of these programs. (Herrera-Yee, 2016).
An additional, suicide prevention resource is crisis hotlines. For instance, the Veteran Crisis Line provides veterans with a chance to communicate with qualified responders. Since its creation, the Veterans Crisis Line has answered more than 3.8 million calls and initiated the dispatch of emergency services to callers in crisis nearly 112,000 times (U.S. Department of Human and Health Services, N.d.). The crisis line is available via an online chat room and has accessibility to veterans with physical limitations. Non-profit agencies have also assisted the veteran population. Vital support is Didi Hirsch, which provides support with suicide prevention, mental health services, and substance abuse programs. Didi Hirsch’s services include providing therapy and support groups for those who have attempted or are bereaved by suicide, evidence-based mental health services, and individual, family and group outpatient services to adolescents and adults struggling with drug, alcohol, and other substance use issues ( Didi Hirsch Mental Health, N.d.).
Lastly, an additional and crucial intervention strategy for helping a veteran or any person that is contemplating suicide is to use the S.A.V.E. method. The S.A.V.E. acronym stands for signs of suicidal thinking, ask questions, validate the persons experience, encourage treatment, and expedite getting help (U.S. Department of Veterans Affairs, N.d.).
There does not appear to be a segment of American society insulated from this tragedy, and understanding the causality of a suicide attempt seems to be a mystery (Caine, 2013). In fact, according to Franklin et al. (2017), there seems to have been little progress in assessing risk factors that predict suicidal thoughts and behaviors. Understanding and preventing suicide is one of the most complex challenges facing suicide experts, psychiatrists, physicians, counselors, and clinicians around the world. Suicide within the veteran population has been a significant concern in recent years. Therefore, suicide is a complex issue with many contributing factors. Unfortunately, the complexity demonstrates that there is no scale, matrix, or instrument for reliably diagnosing the propensity for self-destruction. One event or series of events may lead one to contemplate or follow through with their thoughts of suicide while another person will not seek self-destruction by those same series of events.
References
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- Basu, M. (2013, November 14). Why the suicide rate among veterans may be more than 22 a day. Retrieved from https://www.cnn.com/2013/09/21/us/22-veteran-suicides-a-day/index.html
- Blosnich, J. R., Bossarte, R. M., & Silenzio, V. M. (2012). Suicidal ideation among sexual minority veterans: Results from the 20052010 Massachusetts behavioral risk factor surveillance survey. American Journal of Public Health, 102(S1). doi:10.2105/ajph.2011.300565
- Bumiller, E. (2011, July 22). Obama ends the dont Ask, dont tell policy. Retrieved from https://www.nytimes.com/2011/07/23/us/23military.html
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- Castro, C., Kintzle, S., & Hassan, A. (2014). The State of the American Veteran: The Los Angeles county veterans Study. Retrieved from USC Social Work Center for Innovation and Research on Veterans & Military Families website: http://cir.usc.edu/wp-content/uploads/2013/10/USC010_CIRLAVetReport_FPpgs.pdf
- Didi Hirsch mental health services. (N.d.). Retrieved from https://didihirsch.org/services/
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- Herrera-Yee, I. (2016, February 12). Clay Hunt’s act serves to prevent veteran suicide. Retrieved from https://namimc.org/clay-hunt-act-serves-to-prevent-veteran- suicide/
- Ismay, J. (2016, October 02). Dont ask, dont tell vets still waiting for justice. Retrieved from https://www.scpr.org/news/2016/04/05/59224/4-years-after-the-repeal-of-dont-ask-dont-tell-muc/
- Kemp, J., & Bossarte, R. (2012). Suicide data report, 2012. Department of Veterans Affairs Mental Health Services Suicide Prevention Program. Retrieved https://www.va. gov/opa/docs/Suicide-Data-Report-2012-final.pdf.
- Lee, M. Y. (2015, February 04). The missing context behind the widely cited statistic is that there are 22 veteran suicides a day. Retrieved from https://www.washingtonpost.com/news/fact-checker/wp/2015/02/04/the-missing-context- behind-a-widely-cited-statistic-that-there-are-22-veteran-suicides-a-day/?amp;utm_term=.c9b95d4c6825&noredirect=on
- Price, J. (2015, August 27). Experts question a common statistic: Do 22 veterans a day commit suicide? Retrieved from https://www.wunc.org/post/experts-question- common-statistic-do-22-veterans-day-commit-suicide
- Shane, L. (2018, October 02). VA: The suicide rate for younger veterans increased by more than 10 percent. Retrieved from https://www.militarytimes.com/news/pentagon-congress/2018/09/26/suicide-rate-spikes-among-younger-veterans/
- Shane, L., & Kime, P. (2017, August 08). A New VA study finds 20 veterans commit suicide each day. Retrieved from https://www.militarytimes.com/veterans/2016/07/07/new-va-study-finds-20-veterans-commit-suicide-each-day/
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- U.S. Department of Health and Human Services. (n.d.). Veterans crisis line: Suicide prevention hotline, text & chat. Retrieved from https://www.veteranscrisisline.net/
- U.S. Department of Veterans Affairs. (2019, February 19). Point-in-time (PIT) count. Retrieved from https://www.va.gov/HOMELESS/pit_count.asp
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