Stopping veteran suicide starts on the front lines, not in DC

“When I asked for help, they opened up a Pandora’s box inside of me and just kicked me out the door. That’s how they treat veterans ’round here.” These were the last words of U.S. Army Sergeant John Toombs in a message he’d recorded shortly before taking his own life on VA property, near the emergency room that had reportedly turned him away.

John couldn’t get his memories of combat in Afghanistan out of his head. He had developed a drug problem that landed him in the residential treatment program at the Murfreesboro Veterans Affairs in Tennessee. It was meant to be an intensive therapeutic atmosphere, but it was run more like a proving ground for “tough love” treatment approaches, with draconian discipline policies that made veterans like John feel under constant threat of expulsion, according to David Toombs, John’s father. On the morning of Nov. 22, 2016, John was indeed abruptly kicked out for being late to take his medications. Shortly thereafter, he hanged himself at a construction site where a new VA residential mental health treatment facility is due to be opened.

{mosads}However, none of this was discussed during a hearing before the House Veterans Affairs Committee last night. No personal stories were told. No enhanced accountability measures discussed where system failures clearly occurred.

No real metrics for success were offered that provided receipts for the significant budget increase for suicide prevention programs. Just a three-hour dialogue between senior officials from the VA and members of the committee where everyone simply admired the problem and relished in its complexities while leading the room full of observers to a cul-de-sac of nothing.

At this point, maybe that’s as good as it gets where the VA and our government in Washington, D.C. are concerned. The reality is laws, executive orders, investigations, awareness campaigns, meetings and hearings don’t stop veteran suicide. They may undergird efforts that attempt to do so. But the only thing that stops veterans from killing themselves is “hope.”

It starts with those on the front lines of the problem. The professionals who chose the field of mental health. Most are good people who save lives every single day, who are silent heroes.

You’ll likely never hear about them or their success because they simply do their jobs. That’s what they get paid to do, like firefighters, police officers and service members who put their lives on the line as a matter of routine without attention or fanfare.

But if you want to begin to understand the problem, listen to the veterans themselves who gave us the reasons that explain their fateful decisions. Like retired Marine Colonel James Turner, who said in his parting message, “I bet if you look at the 22 suicides a day you will see VA screwed up in 90% of cases. I did 20+ years, had PTSD and still had to pay over $1,000 a month for health care.”

We also heard sentiments from Sergeant Toombs in his final message. On balance, not every on-campus or parking lot suicide involved a bad experience with VA staff right before the suicide occurred. However, for those that did and nothing changed, that inaction increasingly plagues an institution where hope goes to die for too many veterans.

The fastest way to kill hope is to neutralize it with apathy, where process matters more than people. For example, counterproductive policies that make inter-network transfers between hospitals and PTSD clinics a hassle. Checking boxes instead of relying on instincts or common sense.

Disempowering front-line counselors whose input gets ignored by physicians who prematurely discharge at-risk veterans, sometimes against their will. Ineffective drug treatments that make veterans even sicker instead of offering them non-traditional approaches like equine therapy or yoga or peer-warrior retreats like Boulder Crest or programs like K9s For Warriors.

Another key problem is one of flawed organizational structure. Program offices in VA central office have no authority over those who implement their policy in the field. Suicide prevention coordinators do not report directly to the national program office. They don’t even report directly to the network or facility director.

They’re low enough on the totem pole to have very little say over how those programs are actually executed, which is why we often see a yawning chasm between policy and operations in the Veterans Health Administration. It’s the veterans who often fall into the gaps.

Finally, other problems involve gaps in oversight and accountability. The VA inspector general investigated a suicide at Minneapolis in 2018 and concluded “While the OIG identified … deficits in the care provided to the Patient, the OIG team was unable to determine that any one, or some combination, was a causal factor in the Patient’s death.” Really? Whose job was it to know better? Who was responsible for managing that mental health program locally?

When the veteran in Austin, Texas left a care conference, walked into a VA facility waiting area full of people, and shot himself on April 9th, someone bore the responsibility to protect those VA employees, other veterans, and the veteran himself from himself. The same was true in Georgia where two separate on-campus suicides occurred within hours of each other the week prior. These suicides occurred just a week after another veteran killed himself at a VA facility in West Palm Beach, Fla.

If a veteran dies because he didn’t seek help at all or she didn’t give anyone a chance to intervene, we have to accept the loss in those cases. But for those who enter a VA facility or participate in a treatment program in search of hope, these cases need to be treated like a veritable matter of life and death, each and every time. And when the system falls short, someone needs to be held accountable, each and every time.

Sherman Gillums Jr. served in the U.S. Marine Corps during the Persian Gulf War and Global War on Terror eras, and currently serves as the chief strategy officer for AMVETS.