Suicide by veterans remains a daunting problem as VA struggles to improve care

As with many suicides, nobody saw this one coming.

Back from his service in Afghanistan, Matthew Melanson was part of a tightly knit group of students at Tunxis Community College. The 22-year-old National Guardman from Simsbury was known as an avid snowboarder who also liked off-roading in his Jeep. He took his life on a spring day last year.

Like many returning soldiers and sailors, Melanson suffered from post-traumatic stress disorder. His suicide and those of many veterans like him has alarmed the military and officials at U.S. Department of Veteran Affairs facilities all over the country, who are in a long-standing struggle with the problem.

While there’s evidence some progress has been made, the situation remains daunting, and suicide remains a risk to those who have survived the perils of the battlefield.

The latest national count by the Department of Veterans Affairs showed that 22 veterans take their lives every day. That’s a suicide every 65 minutes.

Connecticut has one of the lowest veteran suicide rates in the nation, about 28.8 per 100,000 veterans enrolled in VA services, according to a VA study. The national rate is 35.9 per 100,000. But the state’s veterans are committing suicide at nearly twice the rate of non-vets. The number of veterans’ suicides in Connecticut has varied from year to year. From 2005 to 2011, the latest available year, the number ranged from a low of 31 in 2009 to an estimated high of 54 in 2011.

Some people, including Linda Schwartz, outgoing head of Connecticut’s Department of Veterans’ Affairs, say the problem is probably a lot greater than reported. “There’s nothing realistic” about suicide statistics, she said, because “a veteran’s death often does not get reported as a suicide.”

Schwartz, who was recently confirmed for a key job at the U.S. Department of Veterans Affairs, said the stigma surrounding suicide, and religious prohibitions on taking one’s life, prevent accurate reporting. Also, only a fraction of veterans receive treatment through the VA system, and medical examiners and others involved in investigating suicides often don’t know if the victim was a veteran.

As for Melanson’s death, “It was kind of a chilling experience,” Schwartz said. “He was found with my business card in his pocket. I wish he had called.”

Schwartz is proud that Connecticut’s federal VA facilities seem to have largely avoided the conditions that prompted outrage and scandal at some veterans’ facilities — one allegation was that unacceptably long wait times for medical appointments were hidden to protect management bonuses.

But the state’s VA hospitals and clinics do have problems.

In February, the West Haven Veterans Administration hospital was cited by the VA inspector general for dirty operating rooms, inadequate supervision and a high absentee rate. Managers at the facility say they have addressed those deficiencies.

Veterans have criticisms

More problems could come to light, however. Connecticut lawmakers, including Sen. Richard Blumenthal, D-Conn., continue to push the VA for more detailed reports on Connecticut facilities compiled after inspections touched off by the scandals.

Individuals who use mental health services at Connecticut mental health centers also have criticisms.

Elvin Rios, a 34-year-old Afghanistan war veteran from New Britain who suffers from post-traumatic stress disorder, said it is difficult to schedule appointments with his psychologist at the Newington VA facility. Sometimes Rios waited as long as three months to see his doctor, he said.

He also had a hard time finding a doctor he could relate to. “The first one I saw actually recommended acupuncture,” Rios said. “She had no clue about what veterans go through.”

The VA says it has been offering alternative therapies as a way of providing veterans with wider choices for care.

Only about one in five veterans uses the VA system for health care. But Rios said he can’t afford private health insurance. And even with private insurance, co-pays and deductibles can be prohibitive. So, Rios said, he’s “stuck with the VA system'” and hopes for “better doctors, better treatments and better ways to schedule appointments.”

David Welsh, a Vietnam War-era veteran who serves as a veterans adviser at Tunxis Community College, said veterans often complain about a lack of access and the difficulties in meeting one-to-one with a therapist to talk out their problems.

“The emphasis that I see at the VA is medication,” Welsh said. “Veterans feel that they are all pushed pills.

Another group of veterans who attend group counseling sessions at the Newington facility are in revolt because their program was recently changed and their counselor, who had cared for them for 10 years, was given a new job.

“It’s really rough on the guys,” said Doug Yaeger, a member of the group and a veteran from Winsted who served in Connecticut’s Army National Guard. “This is a horrible thing to do to people with trust issues. Now we don’t’ have the same level of care.”

Louis A. Trevisan

Louis Trevisan, a psychiatrist at the West Haven VA hospital, said the changes were made in Newington to bring it in line with procedures at West Haven.

“We are one VA,” he said.

Trevisan said the vets who lost their counselor, an advanced practice registered nurse (APRN) named Ron Nardy, have access to other counselors — and to Nardy if they make an appointment.

Trevisan also said there are no long wait times for mental health care at Connecticut’s VA facilities. The standard is to see a new patient within 14 days, he said, “and we do a good job of getting people in.”

A VA audit in May of wait times for mental health appointments at the state’s facilities showed a wide divergence, however, from an average of four days at the West Haven hospital to 28 days at the Waterbury VA clinic and 33 days at the VA facility in Winsted.

Those who threaten suicide often receive immediate attention. But mental health advocates say any veteran who reaches out for mental health services should be seen quickly because screenings don’t always identify all of those who are suicidal.

After that, Trevisan said, follow-up appointments are made “according to clinical issues.” Some veterans, however, would appreciate guidelines that would allow them to receive quicker followup care if they feel they need it.

Connecticut VA facilities provided mental health services to 13,235 veterans last year, which the VA says “equates to 205,633 appointments/clinic stops.” The West Haven hospital has 24-hour-a-day, 7-day-a- week mental health services. The Newington VA facility does not.

In 2007, after devastating reports on the prevalence of veteran suicides, Congress approved a law that required the VA to establish a Veterans Crisis Line, which can be reached at 1-800-273-8255 . The hotline is staffed at all times and is supposed to steer troubled veterans to mental health services even if they are not registered with the VA or enrolled in VA health care. The VA says that, on average, the crisis line receives 786 calls and is responsible for nearly 22 rescues each day.

Congress also mandated that each VA hospital have a suicide prevention coordinator, whose job is to identify high-risk veterans and “promote awareness at the facility about suicide and that suicide prevention is everyone’s responsibility.”

Maureen Pasko

Maureen Pasko is the suicide prevention coordinator at the West Haven VA hospital. She tries to plug holes in the VA’s mental health system, but said many veterans don’t reach out for help, or when they do, mask their symptoms.

“We only capture about 50 percent of what is going on,” Pasko said.

But there’s evidence the VA often drops the ball.

Last year, a VA inspector general’s report found that nearly a third of veterans deemed at high risk for suicide don’t receive the recommended follow-up care after they have been discharged from VA inpatient facilities. The VA requires its clinicians to evaluate these high-risk patients at least once a week after their discharge. Pasko said that policy is in place at West Haven.

She also said the Connecticut VA is trying to reach out to family members to make sure they are aware of the warning signs of suicide. “Sometimes people see the warning signs, and they don’t know what it means,” she said.

Pasko also said there has been an uptick in the numbers of young veterans and female veterans who commit suicide.

Parents become mental health advocates

Before taking his life with a bullet to the head, Daniel Somers, an Iraqi Freedom veteran living in Phoenix, Ariz., wrote a long letter to his family that eloquently detailed his despair and pain. His story became a touchstone for the problem of veterans suicide all over the United States.

“Far better that than to inflict my growing misery upon you for years and decades to come, dragging you down with me…,” Somers wrote. “You will come to see that it is a far better thing as one day after another passes during which you do not have to worry about me or even give me a second thought. You will find that your world is better without me in it.”

Somers suffered from PTSD and had been diagnosed with traumatic brain injury and several other war-related conditions. In his suicide note, Somers condemned a system of “dehumanization, neglect, and indifference” in the treatment of the nation’s veterans.

“Is it any wonder then that the latest figures show 22 veterans killing themselves each day? That is more veterans than children killed at Sandy Hook, every single day. Where are the huge policy initiatives?” Somers asked.

Somers’s parents are now advocates for change.

At a hearing before the House Veterans’ Affairs Committee in July, Howard and Jean Somers told of Daniel’s struggle to get help within the VA system.

Their son was turned away because of his inactive National Guard status, his parents said. When he finally gained admission to the VA system, he was essentially denied therapy and had problems with the VA staff because they were uncaring, insensitive and adversarial, they said.

At one point, their son tried to get himself admitted to the VA hospital in Phoenix, which is at the center of the scandal about wait times. Daniel was having a mental breakdown, his parents said, but he was turned away both in the mental health and emergency departments.

According to Howard Somers, when Daniel broke down crying in a corner of the emergency room, he was told he could stay until he felt well enough to drive himself home. Despite the VA hospital’s proximity to two other health care facilities within less than two miles, he received no help from the Phoenix VA hospital to get to either of them.

“We have to start to think big,” said Jean Somers about an overhaul of the VA system.

Besides updating computer systems and the way appointments are scheduled, the Somerses recommended other changes to Congress, including changing a policy that prohibited Daniel Somers from receiving individual therapy unless he first went to group therapy. Discussing his traumas would have revealed classified information, so he could not be in group therapy, his parents said.

Another thing the couple is lobbying for is allowing vets in the VA system greater access to private mental health practitioners. They also are looking for the VA to tackle the root causes of depression among vets, including joblessness and homelessness.

Jean Somers said the VA is taking strides in that direction.

“They are trying to treat the person holistically,” she said. “They need to look at their entire situation… I think we are on the cusp of turning the corner on that.”

Trevisan, the psychiatrist at the West Haven VA hospital, said there’s a greater focus on “psychosocial issues” now, including substance abuse, homelessness and lack of money and jobs.

Janet Kemp, the National Director for Suicide Prevention and Community Engagement at the U.S. Department of Veterans Affairs, agrees. She said the VA has established a homeless call center and “is constantly pushing initiatives,” including the establishment of an online chat room for troubled veterans and a texting service that connects veterans with staffers at the suicide prevention hotline.

Perhaps most importantly, the VA is working with the Department of Defense to create suicide prevention guidelines and a better transition for vets who need help moving from active service to the VA system.

“We’re really trying to reach people before they are suicidal,” she said.

Kemp said the plague of veteran suicides is “horrible.” But a report she co-wrote on the subject, using data from a number of states, including Connecticut, shows the suicide rate is lower for veterans in the VA system than those outside it, which is for her a small victory.

Meanwhile, the Connecticut Department of Veterans Affairs is pressing all doctors and hospitals in the state to ask their patients if they have served in the military, so that issues like PTSD and other combat-related illnesses can be better diagnosed.