Veteran mental health care: A true lack of leadership

Every day, nearly 20 veterans take their own life. In 2021, the Army saw its highest suicide rate in nearly a century. Recently, the crew of the USS George Washington experienced five suicides, three suicides in just one week, and this is only one U.S. Navy ship. Outside of the military, on average, approximately 125 Americans die by suicide each and every day. Make no mistake about it, COVID-19 is not the only epidemic our country is battling.

The past year we have witnessed an unprecedented series of events that has collectively challenged our nation. A poorly executed withdrawal from Afghanistan, the height of a global pandemic, a war in Ukraine, and if that’s not enough, we are dealing with record-high gas prices, shortages of baby formula and a looming recession.

Is this enough to cause a mental health crisis within the country as many experts are saying? Or is this the “pace” of life that sheds new light on old problems? These are not mere rhetorical questions, but ones that raise significant concerns about the trajectory of our nation’s wellness.

What is our solution to the problem with our nation’s suicide rate and unprecedented levels of collective suffering? It’s the mental health system. Unfortunately, though, not a week goes by that a news story doesn’t highlight how broken the mental health system is in our country. Reduced access to care results in months-long waiting lists to see a mental health professional. Studies reveal less than stellar outcomes from talk therapies and medications for those people who are finally able to be seen.

For many, access to psychiatrists, psychologists, social workers and counselors are not available because of racial, socioeconomic and geographical disparities. And when it seems like help is on its way, bureaucratic bottlenecks keep change from occurring and that can be witnessed in the story about the Brandon Act story. Signed into law in December, the act is intended to allow members of the military to seek confidential mental health care — but the U.S. military has not yet implemented it.

Even the most prestigious “experts” are failing us. In a recent report from the Rand organization, “Defining the Standards of Care for Veteran Mental Health and Brain Health,” we are offered a view of the mental health system that does not match with what people seeking mental health services experience. Overall, the report suggests that veteran mental health care is in “good shape” and on the right track. The irony is that no “patients” were interviewed. I assume this means that it’s the organization, not the patient that determines the standards and quality of care. Many veterans already vote with their feet. Nearly 50 percent of eligible veterans will never see the inside a Veterans Affairs (VA) medical center. You want truth, ask the patients.

In a recent interview with the Los Angeles Times, Andrew Scull ,a sociologist and expert on the history of mental illness and its treatments, suggests that our system has and is failing Americans. His assessment is insightful, balanced and honest. It’s also courageous. It’s courageous, because as Scull points out, those who spend decades training and working as clinicians and scientists are hesitant to admit that what the mental health community has to offer is woefully lacking. Doing so would be potentially detrimental to one’s career and livelihood. Scull’s critique of the former head of the National Institute for Mental Health (NIMH), Thomas Insel, is most notable.

Scull says “Insel spent 13 years in charge of the nation’s mental health research which produced dismal results. That’s not my opinion. It’s his. When Insel stepped down as director of NIMH in 2015, he gave an interview about his accomplishments, after spending by his estimate, $20 billion.”

Insel himself said, “I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that … I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”

Scull continues by saying “actually, the situation is even worse than Insel implies. People with serious mental illness live, on average, 15 to 25 years less than the rest of us, and that gap seems to be widening, not narrowing. While genetics and neuroscience have flourished within the confines of universities, their therapeutic payoff has been minimal or nonexistent.”

Scull’s interview highlights something I have believed for quite some time. In my view, the vast majority of what the VA, Department of Defense and civilian mental health providers see in their offices is the suffering that’s part of the human condition. It’s not only mental illness. And it’s because of this reality, that there are significant limitations on the benefits provided by talk therapies and psychiatric medications.

Imagine a person who can’t get out of bed in the morning or is having suicidal thoughts because his best friend was killed in combat, or their spouse left him or their child passed away. This is not a brain disease or a mental illness. It’s suffering, and suffering like this is unfortunate, and an ever-present part of life. In my opinion, the last thing this person needs is to be run through a predetermined/prescribed set of generic therapeutic techniques for the purpose of “challenging his distorted or maladaptive thinking patterns”.

This person needs a compassionate and caring person who will sit with him and be a part of his suffering, and not someone like the senior enlisted man of the U.S. Navy, or as he is known, the Master Chief Petty Officer of the Navy, who told sailors on the USS George Washington that they should be lucky they’re not Marines in foxholes.

But what do we do when the chain of command lacks emotionally competent leadership? Unfortunately, all we have to offer are talk therapies along with antidepressants, mood stabilizers and sleeping pills — whether or not that addresses a patient’s needs.

Humans have been helping their fellow humans since the beginning of time. What we need is to create far-reaching networks of peer helpers who can compassionately guide others through their struggles and teach people how to manage the inevitable suffering they will face in their lives.

The reality is that the mental health system doesn’t change because the community lacks real leadership. And like Scull, I keep asking “why are things not getting better?”

If military leaders want to fix this, they must fix leadership programs by improving the teachings of emotional intelligence — and like we teach with all other leadership issues, solve these “mental health” issues at the lowest possible levels.

Ken Falke, EOD Master Chief Petty Officer (retired), is a  21-year combat veteran of the U.S. Navy Explosive Ordnance Disposal. He is chairman and founder of Boulder Crest, an organization focused on the teachings of posttraumatic growth. He is also the author of “Struggle Well: Thriving in the Aftermath of Trauma.”