HERE’S a
window into a tragedy within the American military: For every soldier killed on
the battlefield this year, about 25 veterans are dying by their own hands.
An American soldier dies every day and a half, on average, in Iraq or
Afghanistan. Veterans kill themselves at a rate of one every 80 minutes. More
than 6,500 veteran suicides are logged every year — more than the total number
of soldiers killed in Afghanistan and Iraq combined since those wars began.
These unnoticed killing fields are places like New Middletown, Ohio, where
Cheryl DeBow raised two sons, Michael and Ryan Yurchison, and saw them depart
for Iraq. Michael, then 22, signed up soon after the 9/11 attacks.
“I can’t just sit back and do nothing,” he told his mom. Two years later, Ryan
followed his beloved older brother to the Army.
When Michael was discharged, DeBow picked him up at the airport — and was
staggered. “When he got off the plane and I picked him up, it was like he was an
empty shell,” she told me. “His body was shaking.” Michael began drinking and
abusing drugs, his mother says, and he terrified her by buying the same kind of
gun he had carried in Iraq. “He said he slept with his gun over there, and he
needed it here,” she recalls.
Then Ryan returned home in 2007, and he too began to show signs of severe
strain. He couldn’t sleep, abused drugs and alcohol, and suffered extreme
jitters.
“He was so anxious, he couldn’t stand to sit next to you and hear you breathe,”
DeBow remembers. A talented filmmaker, Ryan turned the lens on himself to record
heartbreaking video of his own sleeplessness, his own irrational behavior — even
his own mock suicide.
One reason for veteran suicides (and crimes, which get far more attention) may
be post-traumatic stress disorder, along with a related condition, traumatic
brain injury. Ryan suffered a concussion in an explosion in Iraq, and Michael
finally had traumatic brain injury diagnosed two months ago.
Estimates of post-traumatic stress disorder and traumatic brain injury vary
widely, but a ballpark figure is that the problems afflict at least one in five
veterans from Afghanistan and Iraq. One study found that by their third or
fourth tours in Iraq or Afghanistan, more than one-quarter of soldiers had such
mental health problems.
Preliminary figures suggest that being a veteran now roughly doubles one’s risk
of suicide. For young men ages 17 to 24, being a veteran almost quadruples the
risk of suicide, according to a study in The American Journal of Public Health.
Michael and Ryan, like so many other veterans, sought help from the Department
of Veterans Affairs. Eric Shinseki, the secretary of veterans affairs, declined
to speak to me, but the most common view among those I interviewed was that the
V.A. has improved but still doesn’t do nearly enough about the suicide problem.
“It’s an epidemic that is not being addressed fully,” said Bob Filner, a
Democratic congressman from San Diego and the senior Democrat on the House
Veterans Affairs Committee. “We could be doing so much more.”
To its credit, the V.A. has established a suicide hotline and appointed
suicide-prevention coordinators. It is also chipping away at a warrior culture
in which mental health concerns are considered sissy. Still, veterans routinely
slip through the cracks. Last year, the United States Court of Appeals in San
Francisco excoriated the V.A. for “unchecked incompetence” in dealing with
veterans’ mental health.
Patrick Bellon, head of Veterans for Common Sense, which filed the suit in that
case, says the V.A. has genuinely improved but is still struggling. “There are
going to be one million new veterans in the next five years,” he said. “They’re
already having trouble coping with the population they have now, so I don’t know
what they’re going to do.”
Last month, the V.A.’s own inspector general reported on a 26-year-old veteran
who was found wandering naked through traffic in California. The police tried to
get care for him, but a V.A. hospital reportedly said it couldn’t accept him
until morning. The young man didn’t go in, and after a series of other missed
opportunities to get treatment, he stepped in front of a train and killed
himself.
Likewise, neither Michael nor Ryan received much help from V.A. hospitals. In
early 2010, Ryan began to talk more about suicide, and DeBow rushed him to
emergency rooms and pleaded with the V.A. for help. She says she was told that
an inpatient treatment program had a six-month waiting list. (The V.A. says it
has no record of a request for hospitalization for Ryan.)
“Ryan was hurting, saying he was going to end it all, stuff like that,” recalls
his best friend, Steve Schaeffer, who served with him in Iraq and says he has
likewise struggled with the V.A. to get mental health services. “Getting an
appointment is like pulling teeth,” he said. “You get an appointment in six
weeks when you need it today.”
While Ryan was waiting for a spot in the addiction program, in May 2010, he died
of a drug overdose. It was listed as an accidental death, but family and friends
are convinced it was suicide.
The heartbreak of Ryan’s death added to his brother’s despair, but DeBow says
Michael is now making slow progress. “He is able to get out of bed most
mornings,” she told me. “That is a huge improvement.” Michael asked not to be
interviewed: he wants to look forward, not back.
As for DeBow, every day is a struggle. She sent two strong, healthy men to serve
her country, and now her family has been hollowed in ways that aren’t as tidy,
as honored, or as easy to explain as when the battle wounds are physical. I
wanted to make sure that her family would be comfortable with the spotlight this
article would bring, so I asked her why she was speaking out.
“When Ryan joined the Army, he was willing to sacrifice his life for his
country,” she said. “And he did, just in a different way, without the glory. He
would want it this way.”
“My home has been a nightmare,” DeBow added through tears, recounting how three
of Ryan’s friends in the military have killed themselves since their return.
“You hear my story, but it’s happening everywhere.”
We refurbish tanks after time in combat, but don’t much help men and women
exorcise the demons of war. Presidents commit troops to distant battlefields,
but don’t commit enough dollars to veterans’ services afterward. We enlist
soldiers to protect us, but when they come home we don’t protect them.
“Things need to change,” DeBow said, and her voice broke as she added: “These
are guys who went through so much. If anybody deserves help, it’s them.”
PALO ALTO,
Calif. — Before going to war, Susan Max loved tooling around Northern California
in her maroon Mustang. A combat tour in Iraq changed all that.
Back in the States, Ms. Max, an Army reservist, found herself avoiding cramped
parking lots without obvious escape routes. She straddled the middle line, as if
bombs might be buried in the curbs. Gray sport-utility vehicles came to remind
her of the unarmored vehicles she rode nervously through Baghdad in 2007, a
record year for American fatalities in Iraq.
“I used to like driving,” Ms. Max, 63, said. “Now my family doesn’t feel safe
driving with me.”
For thousands of combat veterans, driving has become an ordeal. Once their
problems were viewed mainly as a form of road rage or thrill seeking. But
increasingly, erratic driving by returning troops is being identified as a
symptom of traumatic brain injury or post-traumatic stress disorder, or P.T.S.D.
— and coming under greater scrutiny amid concerns about higher accident rates
among veterans.
The insurance industry has taken notice. In a review of driving records for tens
of thousands of troops before and after deployments, USAA, a leading insurer of
active-duty troops, discovered that auto accidents in which the service members
were at fault went up by 13 percent after deployments. Accidents were
particularly common in the six months after an overseas tour, according to the
review, which covered the years 2007-2010.
The company is now working with researchers, the armed services and insurance
industry groups to expand research and education on the issue. The Army says
that fatal accidents — which rose early in the wars — have declined in recent
years, in part from improved education. Still, 48 soldiers died in vehicle
accidents while off duty last year, the highest total in three years, Army
statistics show.
The Pentagon and Department of Veterans Affairs are also supporting several new
studies into potential links between deployment and dangerously aggressive or
overly defensive driving. The Veterans Affairs health center in Albany last year
started a seven-session program to help veterans identify how war experiences
might trigger negative reactions during driving. And researchers in Palo Alto
are developing therapies — which they hope to translate into iPhone apps — for
people with P.T.S.D. who are frequently angry or anxious behind the wheel.
“I can’t talk with somebody who is a returned service member without them
telling me about driving issues,” said Erica Stern , an associate professor of
occupational therapy at the University of Minnesota, who is conducting a
national study of driving problems in people with brain injuries or P.T.S.D. for
the Pentagon.
Though bad driving among combat veterans is not new — research has found that
Vietnam and Persian Gulf war veterans were more likely to die in motor vehicle
accidents than nondeployed veterans — experts say Iraq and Afghanistan veterans
are unique, for one major reason: their combat experiences were frequently
defined by dangers on the road, particularly from roadside bombs.
“There is no accepted treatment for this,” said Dr. Steven H. Woodward , a
clinical psychologist with the Veterans Affairs Palo Alto Health Care System who
is leading a study of potential therapies for veterans with P.T.S.D.-related
driving problems. “It’s a new phenomenon.”
Though there has been some research into road rage among veterans, therapists
and psychologists have only recently begun to view traumatic brain injuries and
P.T.S.D. as factors in prolonging driving problems, probably by causing people
to perceive threats where none exist — such as in tunnels, overpasses,
construction crews or roadside debris.
“In an ambiguous situation, they are more likely to see hostile intent,” said
Eric Kuhn , a psychologist with the Palo Alto Veterans Affairs Health Care
System, who has studied driving problems. He said his research found that
veterans who report more severe P.T.S.D. symptoms also tend to report being more
aggressive drivers.
Experts note that driving problems are not always the result of the disorder. In
some cases, returning troops may be reflexively applying driving techniques
taught in Iraq during the height of the insurgency — for example, speeding up at
intersections to avoid gunfire or scanning the roadside for danger instead of
watching the road ahead.
In a study of Minnesota National Guard soldiers who returned from Iraq in 2007,
Dr. Stern and fellow researchers found that a quarter reported driving through a
stop sign and nearly a third said they had been told they drove dangerously in
the months immediately after their tours. Both results were higher than the
answers reported by National Guard cadets who had not been deployed.
Though driving problems seemed to decrease the longer the troops were home, they
did not always vanish. Dr. Stern found that many Guard members remained anxious
about certain roadway situations, including night driving or passing unexpected
things.
“Those are things they associated with threats they saw in combat,” she said.
Ms. Max, a grandmother of four, was deployed at the age of 60 to Iraq, where one
of her jobs was to carry large sums of cash to Iraqi reconstruction projects
outside fortified American bases. She said she learned to be hypervigilant on
those trips.
Upon returning to California, she struggled with P.T.S.D. and took time off from
her nursing job. She also noticed feeling nervous for the first time in her life
about driving — a major problem because she had to drive to visit patients.
“My whole driving behavior changed,” she said. “I live in a state of anxiety
when I’m driving.”
Ms. Max recently participated in a clinical trial to develop and test therapies,
such as deep breathing, that might overcome such anxieties. In a Pontiac
Bonneville sedan outfitted with equipment to track the driver’s visual focus,
heart rate and breathing, as well as to measure changes in the speed and
direction of the car, the researchers take patients onto highways and observe
their reactions to traffic hazards, real and imagined.
On a recent spin through the hills of Palo Alto, Ms. Max drove while Dr.
Woodward monitored her heart rate and breathing on a laptop in the back seat. In
front, Marc Samuels, a driving rehabilitation specialist who offers one of the
only programs for P.T.S.D.-related driving problems in the nation, directed her
along a preplanned route, prepared to grab the wheel if anything went awry.
Ms. Max mostly drove fine, but was startled slightly when passing a construction
site and then again when two cars momentarily boxed her in. Finally, when her
stress level spiked in a small parking lot, Mr. Samuels told her to stop the car
and regain her composure.
Ms. Max said that the clinics had made her more aware of the things that made
her nervous, a first step to conquering them. But she says she does not expect
to ever feel truly comfortable driving again and has no plans to replace her
beloved Mustang, which she sold just before her deployment.
“Why get a hot car?” she said. “I’m not going to enjoy it.”
September
27, 2011
The New York Times
By CATRIN EINHORN
RAY CITY,
Ga.— April and Tom Marcum were high school sweethearts who married after
graduation. For years, she recalls, he was a doting husband who would leave love
notes for her to discover on the computer or in her purse. Now the closest thing
to notes that they exchange are the reminders she set up on his cellphone that
direct him to take his medicine four times a day.
He usually ignores them, and she ends up having to make him do it.
Since Mr. Marcum came back in 2008 from two tours in Iraq with a traumatic brain
injury and post-traumatic stress disorder, his wife has quit her job as a
teacher to care for him. She has watched their life savings drain away. And she
has had to adjust to an entirely new relationship with her husband, who faces a
range of debilitating problems including short-term memory loss and difficulties
with impulse control and anger.
“The biggest loss is the loss of the man I married,” Ms. Marcum said, describing
her husband now as disconnected on the best days, violent on the worst ones.
“His body’s here, but his mind is not here anymore. I see glimpses of him, but
he’s not who he was.”
Ms. Marcum has joined a growing community of spouses, parents and partners who,
confronted with damaged loved ones returning from war who can no longer do for
themselves, drop most everything in their own lives to care for them. Jobs,
hobbies, friends, even parental obligations to young children fall by the
wayside. Families go through savings and older parents dip into retirement
funds.
Even as they grieve over a family member’s injuries, they struggle to adjust to
new daily routines and reconfigured relationships.
The new lives take a searing toll. Many of the caregivers report feeling
anxious, depressed or exhausted. They gain weight and experience health
problems. On their now frequent trips to the pharmacy, they increasingly have to
pick up prescriptions for themselves as well.
While taking comfort that their loved ones came home at all, they question
whether they can endure the potential strain of years, or even decades, of care.
“I’ve packed my bags, I’ve called my parents and said I’m coming home,” said
Andrea Sawyer, whose husband has been suicidal since returning from Iraq with
post-traumatic stress disorder. “But I don’t. I haven’t ever physically walked
out of the house.”
Those attending to the most severely wounded must help their spouses or adult
children with the most basic daily functions. Others, like Ms. Marcum, act as
safety monitors, keeping loved ones from putting themselves in danger. They
drive them to endless medical appointments and administer complicated medication
regimens.
One of the most frustrating aspects of life now, they say, is the bureaucracy
they face at the Department of Defense and the Department of Veterans Affairs,
from problems with the scheduling of medical appointments to being bounced
around among different branches of the system, forcing them to become navigators
and advocates for their loved ones.
A variety of care services are offered to the severely injured. But many family
members do not want their loved ones in nursing homes and find home health
services often unsatisfactory or unavailable.
Despite Ms. Marcum’s cheerful manner and easy laugh, she has started taking
antidepressants and an anti-anxiety medication when needed. She has developed
hypertension, takes steroids for a bronchial ailment that may be stress related,
and wears braces to relieve a jaw problem.
“I just saw all of my dreams kind of vanishing,” she said.
Over the past few years, advocacy organizations like the Wounded Warrior Project
lobbied Congress to pass a law providing direct financial compensation and other
benefits to family caregivers of service members. In 2010 they succeeded, and by
mid-September, the veterans agency had approved 1,222 applications, with average
monthly stipends of $1,600 to $1,800. Caregivers can also receive health
insurance and counseling.
“We know it doesn’t replace full lost income,” said Deborah Amdur, who oversees
caregiver support for the agency. “It’s really a recognition of the kinds of
sacrifices that are being made.”
While families express deep gratitude for the help, questions remain about who
will qualify and how compensation is determined, advocates for veterans say.
Furthermore, the law applies only to caregivers of service members injured in
the line of duty on or after Sept. 11, 2001, eliminating help for thousands who
served in earlier conflicts.
And the emotional strain is still palpable as families struggle to adjust to
what many call their “new normal.”
In a reversal of the classic situation in which adult children help out ailing
parents, a substantial number of the caregivers of post- Sept. 11 service
members are parents caring for their adult children.
Rosie Babin, 51, was managing an accounting office when a bullet tore through
her son Alan’s abdomen in 2003. She and her husband rushed to Walter Reed Army
Medical Center and stayed at his side when Alan, then 22, arrived from Iraq. He
lost 90 percent of his stomach and part of his pancreas. His kidneys shut down
and he had a stroke, leaving him with brain damage. He eventually underwent more
than 70 operations and spent two years in hospitals, his mother said.
Ms. Babin fought efforts by the military to put her son in a nursing home,
insisting that he go into a rehabilitation facility instead, and then managed to
care for him at home.
But since her son’s injuries, her doctor has put her on blood pressure
medication and sleeping pills. Now, while deeply grateful for her son’s
remarkable recovery — he gets around in a wheelchair and has regained some
speech — she sadly remembers the days when she looked forward to travel and
dance lessons with her husband. Instead, she helps Alan get in and out of bed,
use the bathroom and shower.
“I felt like I went from this high-energy, force-to-be-reckoned-with
businesswoman,” she said, “to a casualty of war. And I was working furiously at
not feeling like a victim of war.”
Research on the caregivers of service members from the post-Sept. 11 era is just
beginning, said Joan M. Griffin, a research investigator with the Minneapolis
V.A. Health Care System who is leading one such study. (The V.A. estimates that
3,000 families will benefit from the new caregiver program; 92 percent of the
caregivers approved so far are women.)
What makes the population of patients receiving care different, Ms. Griffin
said, is their relative youth. “The V.A. has not had a significant influx of
patients of this age group since Vietnam,” she said, with a result that
caregivers are looking at a “long horizon of providing care.” And one in five
returning service members, a previous study found, report symptoms of
post-traumatic stress disorder or major depression.
Ms. Griffin’s research shows that many family members spend more than 40 hours a
week providing care. Half feel that they do not have a choice.
“They feel stuck,” Ms. Griffin said.
Some walk away.
For Ms. Marcum, 37 — who has an 18-year marriage and two sons, ages 14 and 11,
with Tom, 36 — there was never a question of leaving. “I’m his wife and it’s my
job, whether he’s hurt or not, to make sure he’s O.K.,” she said.
When she first asked for a leave of absence from work to care for him, she
expected it would be for just a few weeks, while doctors got to the bottom of
the migraines keeping him in bed for days on end. When he was up, he often
seemed confused and sometimes slurred his speech. After 12 years in the Air
Force, where he worked as a weapons specialist, he was suddenly having trouble
taking a phone message or driving home from the base.
Mr. Marcum, who endured several mortar attacks in Iraq, one of which knocked him
unconscious, eventually was given diagnoses of traumatic brain injury and
post-traumatic stress disorder.
“My wife, I would imagine, probably felt as if she was a single parent for a
while,” said Mr. Marcum, who is now medically retired from the Air Force. “She
had to raise two boys. And now at times she probably thinks that she’s raising
three boys,” he added with a laugh.
Ms. Marcum has found relief at a weekend retreat for military wives in her
situation, and on a private Facebook page where caregivers vent, offer emotional
support and swap practical advice. Participants say online communities like
these are often more supportive than their extended families, who sometimes
retreat in the face of such overwhelming change.
Financially, at least, things are looking up for the Marcum family. Ms. Marcum
was awarded the highest tier of coverage through the veterans agency’s new
caregiver program, giving her a monthly stipend of $1,837. Physical,
occupational and speech therapy have all helped Mr. Marcum improve, but she
worries that his progress has plateaued.
“We kind of have been in the same spot for a while,” Ms. Marcum said.
As proud as she is of her husband’s service, Ms. Marcum feels guilty that
neither of them now works, and hopes that one day she will again hold down a
job, while continuing to care for him. She pictures herself working somewhere
relaxed, like a Hallmark store, where she could chat with people and help them
with cards and gifts. It would be an escape, she said, from the stress at home.
A new study has found that more than one-third of Iraq and Afghanistan war
veterans who enrolled in the veterans health system after 2001 received a
diagnosis of a mental health problem, most often post-traumatic stress disorder
or depression.
The study by researchers at the San Francisco Department of Veterans Affairs
Medical Center and the University of California, San Francisco, also found that
the number of veterans found to have mental health problems rose steadily the
longer they were out of the service.
The study, released Thursday, was based on the department health records of
289,328 veterans involved in the two wars who used the veterans health system
for the first time from April 1, 2002, to April 1, 2008.
The researchers found that 37 percent of those people received mental health
diagnoses. Of those, the diagnosis for 22 percent was post-traumatic stress
disorder, or PTSD, for 17 percent it was depression and for 7 percent it was
alcohol abuse. One-third of the people with mental health diagnoses had three or
more problems, the study found.
The increase in diagnoses accelerated after the invasion of Iraq in 2003, the
researchers found. Among the group of veterans who enrolled in veterans health
services during the first three months of 2004, 14.6 percent received mental
health diagnoses after one year. But after four years, the number had nearly
doubled, to 27.5 percent.
The study’s principal author, Dr. Karen H. Seal, attributed the rising number of
diagnoses to several factors: repeat deployments; the perilous and confusing
nature of war in Iraq and Afghanistan, where there are no defined front lines;
growing public awareness of PTSD; unsteady public support for the wars; and
reduced troop morale.
Dr. Seal said the study also underscored that it can take years for PTSD to
develop. “The longer we can work with a veteran in the system, the more likely
there will be more diagnoses over time,” said Dr. Seal, who is co-director of
the mental health clinic for Iraq and Afghanistan veterans at the San Francisco
veterans medical center.
The new report joins a growing body of research showing that the prolonged
conflicts, where many troops experience long and repeat deployments, are taking
an accumulating psychological toll.
A telephone survey by the RAND Corporation last year of 1,965 people who had
been deployed to Iraq or Afghanistan found that 14 percent screened positive for
PTSD and 14 percent for major depression. Those rates are considerably higher
than for the general public.
“The study provides more insight as to just how stressed our force and families
are after years of war and multiple deployments,” said René A. Campos, deputy
director of government relations for the Military Officers Association of
America. “Our troops and families need more time at home — more dwell time,
fewer and less frequent deployments.”
The study was posted Thursday on the Web site of The American Journal of Public
Health.
Dr. Seal cautioned that, unlike the RAND study, the results from her research
could not be extrapolated to the roughly 1.6 million veterans who have served in
Iraq or Afghanistan because about 60 percent of them were not receiving health
care through the veterans system.
But she noted that the number of Iraq and Afghanistan war veterans receiving
care through the veterans system was at a historic high, 40 percent, potentially
making the study’s results more universal.
The study also found that veterans older than 40 with the National Guard or the
Reserves were more likely to develop PTSD and substance abuse disorders than
those under 25. A possible reason, Dr. Seal said, is that older reservists go to
war from established civilian lives, with families and full-time jobs, making
combat trauma potentially more difficult to absorb.
“It’s the disparity between their lives at home, which they are settled in, and
suddenly, without much training, being dropped into this situation,” she said.
In contrast, the study found that among active-duty troops, veterans under 25
were more likely to develop PTSD and substance abuse problems than those over
40, possibly because those younger troops were more likely to have been involved
in front-line combat, Dr. Seal said.
CANANDAIGUA, N.Y. — Nancy Nosewicz was busy fielding calls at
the new national veterans hot line on a recent afternoon when someone from the
Department of Veterans Affairs in Topeka, Kan., phoned. He had a 55-year-old
Army veteran from the Northwest on the line who had called to complain about his
benefits, but now the guy, drunk and crying, was talking about not wanting to
live. Could Ms. Nosewicz pick up?
In a slurred voice, heavy from weeping, the veteran, named Robert, told her that
he was homeless and wanted to “just lay down in the river and never get up.”
Ms. Nosewicz, a social worker, listened. Then in a voice firm and comforting
like a big sister, she said: “We don’t want you to either. Today we’re not
thinking about the alcohol or the housing, Robert. Today it’s about keeping you
safe.”
She gave an assistant Robert’s phone number to find his address and alert local
police to stand by. The chain of care resembled a relay race, with one runner
trying not let go of the baton until the next runner had it in hand.
The veterans hot line is part of a specialized effort by the Department of
Veterans Affairs to reduce suicide by enabling counselors, for the first time,
to instantly check a veteran’s medical records and then combine emergency
response with local follow-up services. It comes after years of criticism that
the department has been neglecting tens of thousands of wounded service men and
women who have returned from war zones in Iraq and Afghanistan.
On Monday, a class action suit brought by veterans groups opened in San
Francisco charging a “systemwide breakdown,” citing long delays in receiving
disability benefits and flaws in the way discharged soldiers at risk for suicide
had been treated. Kerri J. Childress, a department spokeswoman, said Monday that
there were an average of 18 suicides a day among America’s 25 million veterans
and that more than a fifth were committed by men and women being treated by
Veterans Affairs.
Up and running since August, the hot line tries to respond to at least some of
those in crisis. Over eight months, it has received more than 37,200 calls and
made more than 720 rescues — sending out, from a narrow office here in upstate
New York, emergency responders all over the country to find someone on a bridge,
with a gun in his hand, with a stomach full of pills.
Paul Sullivan, the director of Veterans for Common Sense, one of the groups
involved in the lawsuit, said of the department: “I’m pleased they’re
responding. However, much more needs to be done so vets aren’t turned away from
health care and don’t have to wait for benefits.”
Mr. Sullivan says suicidal patients have not been able to get care promptly; he
cited the case of Jonathan Schulze, who was turned away twice from a Veterans
Affairs hospital before he killed himself in January 2007.
“More than 600,000 veterans are waiting, on average, more than six months for
disability benefits,” said Mr. Sullivan, who worked at the department monitoring
benefits.
Experts agree that veterans are more likely, perhaps twice as much, to commit
suicide as people who have never served in the military. Meanwhile, a study
released last week by the RAND Corporation estimates that roughly one in five
veterans of Iraq and Afghanistan has symptoms of post-traumatic stress disorder,
which heightens the risk of suicide.
Yet whatever larger failings may exist, the staff of social workers, addiction
specialists and nurses who keep the hot line running — 24 hours a day, seven
days a week — can count at least some victories by the end of each shift.
Unique about this hot line, said Janet Kemp, the national suicide prevention
coordinator with the department, is that now the counselors have medical
information at their fingertips, which they use to connect vets with counseling
near their homes. The model evolved from a new research program on suicide
prevention paid for by the department.
“For years people thought that asking questions about suicide put the thought in
people’s mind, but now we know that’s not true,” said Dr. Kemp, who travels
throughout the country training V.A. staff.
The department is spending about $3 million to start and operate the hot line
during its first year, said a spokesman, Daniel Ryan, and another $2.9 million
on a mental health research center at the sprawling red-brick V.A. Medical
Center in Canandaigua. Referring to the hot line’s relay model, Kerry Knox, the
director of the new research center, said, “You don’t want them to fall through
the cracks.”
With Robert, for example — whose last name was not provided for confidentiality
— Ms. Nosewicz gradually nudged him to agree to be taken to a hospital and to
give his name and Social Security number so she could check his file and put him
in contact with the department’s suicide prevention coordinator in his area.
Meanwhile, Denise Slocum, a health assistant, relayed questions from the local
police dispatcher. “The police are asking if you’re near an elementary school,”
asked Ms. Nosewicz, who then nodded her head at Ms. Slocum.
“No, no, no — no handcuffs,” Ms. Nosewicz reassured Robert. “You’re going to go
to the hospital.”
“Do you have a tissue to blow your nose? Then use your sleeve.”
“When they come in, you put them on the phone with me, and I’ll tell them to
treat you with respect.”
Twenty minutes later, Ms. Slocum called the police again to confirm that Robert
had been taken to a hospital. Ms. Nosewicz alerted the prevention coordinator.
One is at each of the department’s 156 health centers.
Robert’s name was added to a board near the doorway so that the staff could
follow up to ensure a local counselor actually met with him.
Of course, sometimes a crack is unavoidable.
“He’s going to do it. He’s really going to do it,” said Terri Rose, a counselor
who was working the noon-to-midnight shift. She was wiping her red-rimmed eyes.
A caller from Texas, who said he was 65 and a helicopter gunner in Vietnam, said
he had a suicide pact with his friend, but the friend had gone off and killed
himself. Now he, too, was ready to die, saying he had even found a coffin for
$150, said Ms. Rose, who is an Air Force veteran herself. The veteran hung up
and had stopped answering her calls.
Sometimes veterans have a lot of trouble asking for help, said Jacalyn
O’Loughlin, a counselor. “They keep saying, ‘I’m sorry, I’m sorry, I’m sorry,’ ”
Ms. O’Loughlin said. “Especially marines. They feel they’re weak if they reach
out.”
Mr. Ryan said about half the calls to the hot line — 1-800-273-TALK (8255) —
were from veterans, split fairly evenly between Vietnam and Iraq. Family members
and friends also frequently call. About 30 percent of the veterans are women.
A couple of months ago, Ms. O’Loughlin said, a distraught woman called from
Oregon who was driving to the woods and then threatened to “walk and walk and
walk and never come back.” Ms. O’Loughlin rang the tiny silver bell on her desk
to signal the health technician. The health tech checked the area code and
phoned the closest Veterans Affairs health center.
“And lo and behold, that suicide prevention coordinator knew her just by her
first name,” Ms. O’Loughlin said. The tech called the police and the coordinator
called the woman’s husband, getting the car’s make and model. Ms. O’Loughlin
kept her on the line; when she hung up, Ms. O’Loughlin called her back. “This
went on for hours,” she said. “I could hear her getting out of the car. I could
hear the rustling from the leaves.”
Meanwhile, the police and her husband were driving up and down roads. They
spotted the car, dashed through the trees and found her. She had a bottle of
pills in her hand but had not yet swallowed them.
Sometimes, the victories are smaller but no less satisfying. That morning, Ms.
Nosewicz spoke to a veteran whose house was destroyed by Hurricane Katrina; he
had been relocated to a different state.
“He called crying because he can’t find a job, saying ‘my teeth are so rotten
and my mouth stinks,’ ” Ms. Nosewicz said.
Dental referrals are not exactly part of the job description, but Ms. Nosewicz
tried dental schools in his area until she found a school to do the work. “He
was crying on the phone,” she recalled, “and said, ‘Thanks so much. Thanks so
much.’ ”
All in all not a bad day’s work, Ms. Nosewicz said, as she got ready to leave.
“Three rescues, four consults and one set of teeth.”
An earlier version of this article referred incorrectly
to the Department of
Veterans Affairs, known as the V.A.,
