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Reducing veteran suicides, one step at a time

Minnesota Rep. Tim Walz is close to pushing a “first-step” veterans’ mental health bill through Congress, but everyone acknowledges more needs to be done.

REUTERS/Lucas Jackson

WASHINGTON — Clay Hunt was a Marine veteran, a soldier who served in Iraq and Afghanistan, who volunteered in earthquake-ravaged Haiti and Chile and went on long-distance bike rides to keep his war-induced depression at bay. He also sought treatment at Veterans Affairs hospitals, but, as his family told 60 Minutes, was frustrated by scheduling delays and the type of treatment he found there.

In March 2011 he shot himself in his Houston apartment, at the age of 28.

Last year, a group of lawmakers, led in part by Minnesota Rep. Tim Walz, took up the cause of Hunt and his fellow veterans, and this week, just days into a new Congress, the House passed the Clay Hunt SAV Act. The bill aims to reduce veteran suicides by doing three things: it directs the VA to create a website listing its mental health offerings for veterans, it requires a yearly review of the effectiveness of those services, and it creates a student loan repayment program to help the VA recruit and hire new psychiatrists, up to 10 per year.

A version of the same bill passed last December but stalled in the Senate when Sen. Tom Coburn placed a hold on the legislation, citing its $22 million price tag. Coburn has since retired, and the bill’s unanimous passage in the House this week, coupled with bipartisan support in the Senate, means it will likely become law.

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Veteran suicide is a daunting challenge — The VA estimates veterans are committing suicide at a rate of 22 per day — and Walz and other advocates acknowledge that this bill — if it passes — will only address a small part of the problem. Yet in a Washington political environment hostile to sweeping actions, advocates are embracing a more piecemeal approach to the issue, passing scaled-down bills, making sure they’re implemented properly, and seeing what works and what doesn’t along the way.

“What we want to make sure, though, is that it’s not viewed as, oh we did something on, let’s move on,” Walz said. “This is a place that moves on to what’s the next thing.”

Better coordination between departments

Walz’s original Clay Hunt bill concerned not just Veterans Affairs but also the Department of Defense — which cares for active duty personnel — and would have mandated better coordination between the two agencies’ health care services.

The bill would have created programs that intersect between both Defense and Veterans Affairs so that when a service member retires, records and treatment plans transition between the departments. That proposal was pulled to speed up passage of a slimmed-down bill, but Walz hopes to use his new spot on the House Armed Services Committee to work on bringing the DOD and VA closer together on mental health care.

“Since I’ve been here I’ve talked about the lack of seamless transition,” Walz said. “It really was, and it still is to a certain degree: you leave the military and you fall off a cliff and then you try to figure out how to get back in VA, which is just stupid.”

Jackie Maffucci, the research director for the veterans’ group Iraq and Afghanistan Veterans for America — which put out a white paper on addressing veteran suicide last year — said improved records coordination between DOD and VA would allow the VA, an opt-in organization, to better market to potential beneficiaries of their programs. Through 2013, less than 60 percent of Iraq and Afghanistan veterans were using VA care, according to VA records. Among those who do use the VA, mental health problems are the second-most diagnosed aliment.

Right now, the two departments can view each other’s records, Maffucci said, but the system is convoluted. The goal, she said, is a system “where regardless of if you’re being seen at DOD or VA, there’s one window with all the records.”

Personality disorders

Walz has also introduced legislation meant to address the availability of VA mental health services for veterans who may have been discharged due to mental-health problems.

Veterans who are dishonorably discharged — due, for example, to behavioral problems — are not eligible to receive VA care, including mental health services. A 2011 report from the Vietnam Veterans of America estimated that up to 30,000 service members were discharged due to misdiagnosed “personality disorder” issues between 2001 and 2011. Walz said lawmakers should reassess whether those individuals should be eligible to receive mental health care through the VA.

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Last session, Walz introduced a bill that would have required a review of discharges based on personality disorders, which are considered pre-existing conditions but could be attributed to PTSD or other combat-related trauma.

And even if those disorders were present before enlistment, “My take is, you broke it you own it,” Walz said. “You should have not enlisted them if that was the case… I’m of the belief that these people were treated unfairly… they can at least now get care under [the Affordable Care Act], but they should be getting VA care.”

Finding more psychiatrists

Mental trauma and suicide among veterans obviously isn’t a new problem, but it’s something that’s become more traceable in recent years.

Paul Summergrad, the president of the American Psychiatric Association, attributed the problem to the rise of head injuries from Improvised Explosive Devices, but also to improvements in medical care — soldiers are surviving injuries that would have killed them in past conflicts.

Today, though, that translates to high demand for psychiatrists in the VA system. A 2012 VA Inspector General’s report found that more than 70 percent of the system’s mental health staffers said their facilities were too understaffed to meet veterans’ needs. Summergrad said his organization’s members are on board with finding a solution, though one hasn’t emerged yet.

The Clay Hunt bill looks to change that by offering student loan repayment for trained psychiatrists who work in the VA system. Walz said it’s a best practice suggested by providers, though he said he’s afraid it might not be enough.

“You have to be able to pay them somewhat similar to the private sector,” he said. “And if we’re not able to do that, we might be able to do something in terms of: entice them through student loan payments.”

Mental health parity, more research

Groups are looking at other aspects of the problem as well.

Summergrad said lawmakers should work to institute mental health parity — the concept that mental health should be covered as thoroughly as physical health — throughout the private sector, a plan Walz agrees with (Minnesota has a history of parity advocates, including Paul Wellstone and Jim Ramstad).

Walz said he hopes to be a voice for the National Guard on the Armed Services Committee, and he’s already proposed making sure reservists have access to the same mental health proposals as active duty personal. And both Summergrad and Walz said the government should help fund more research into the effects of military service on mental health.

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A long-term process

Walz acknowledged that the next legislative steps on mental health are likely more than a year away. Advocates say they need to make sure the Clay Hunt proposals work first — and, in fact, need to decide what metrics they should use to even decide what that means.

“This is going to be a bit more of a longer-term process,” IAVA’s Maffucci said. “We’re not going to see outcomes in a month or two.”

Walz, who attributes last year’s uproar over VA wait times with helping to prod along passage of Clay Hunt, said he hopes to keep the issue on lawmakers’ radar.

“I don’t like the cliché of we can’t wait another day. On this one I think it fits. I do think we’re going to have to get a body of research to see, and this may take several years … we hope we’ll see numbers reducing because of this.”