Executive Order hoped to turn the tide of military suicides

This summer, the steadily rising rates of suicides by veterans showed with excruciating clarity that something in the health care system waiting after troops had served in combat wasn’t working. On August 31, the response came. President Obama signed an Executive Order aimed at improving access to mental health services for veterans, troops, and military families. An Executive Order is a big deal:  It is an order that agencies must follow, urgent enough that it cannot wait for Congress, and important enough to warrant rapid presidential action.  

The President’s Executive order sets out clear requirements for suicide prevention and provider hiring and placement:

Suicide prevention

·       Increase VA Veterans’ Crisis line capacity by 50 percent by the end of the year.

·       VA must ensure that any veteran who says he or she is in crisis connects with the trained mental health worker in 24 hours or less.

·       The VA and the Department of Defense will set up a 12-month suicide prevention campaign aimed at connecting veterans to mental health services.

Provider hiring and placement

·       In areas where there are problems hiring mental health service providers or long wait times, the VA in partnership with the Department of Health and Human Services (HHS) must establish at least 15 pilot sites where the VA will contract with community providers.

·       HHS and the VA will develop a plan for rural mental health providers to be recruited.

·       The VA will hire 800 peer-to-peer support counselors to empower veterans to support other veterans.

·       The VA will hire 1,600 new mental health professionals and place them by June, 2013. Since 2009, the VA has hired more than 3,500 mental health professionals.

Time for a fresh start

“For quite some time we have been raising the issue that we need a fresh start,” Ron Manderscheid, Ph.D., executive director of the National Association of County Behavioral and Developmental Disability Directors, told Behavioral Healthcare. “The indicator that things weren’t working was the high suicide rate,” said Manderscheid. “They had the highest suicide rate in July than they’ve ever had, and then they’ve had other cases, not all reported, where people have had meltdowns,” he said.

When an adult has a meltdown, it can be violent – violence directed against self or others. Though these meltdowns can manifest varying degrees of severity, all are driven by built-up pain and suffering that could be assuaged if appropriate help were available.

“You go to Iraq or Afghanistan and you’re on a psychological high the whole time because you think you’re going to be blown up,” said Manderscheid. “Then then you come home and all of that is gone, you’re a couch potato in front of a TV without a job, you probably have family problems and child problems. How do we expect you to react?” Many drink, many think about suicide.

Manderscheid thinks that before any veterans return home, they ought to be connected with a peer who will work to help each returnee with the tasks of finding a job, connecting with social services, and reconnecting with their families. “We need to do these upstream things, and then we’ll prevent the downstream problems,” he said.

Since September 11, 2001, more than two million Americans have served in Iraq or Afghanistan, enduring long and repeated deployments and intense combat conditions. And the homecomings of these veterans do not mean an end to their personal battles.  

“History shows that the costs of war will continue to grow for a decade or more after wars have ended,” said Eric K. Shinseki, Secretary of Veterans Affairs, upon the signing of the Executive Order. “The mental health and well-being of the brave men and women who have served the Nation is the highest priority for the Department of Veterans Affairs.” He went on to say that VA would work with federal partners to implement the President’s executive order immediately.

Each of the 152 VA Medical Centers has a suicide prevention coordinator or team. So far, more than 650,000 calls have been made to the Veterans’ Crisis line, including over 440,000 from veterans, family members, or friends. Of these calls, more than 23,000 involved the counseling and rescue of actively suicidal veterans.

Workforce expansion

Under requirements of the President’s Executive Order, the VA is to hire 1,600 more staff members, including an array of mental health professionals:  “psychologists, psychiatrists, nurses, social workers, licensed marriage and family therapists, licensed professional mental health counselors, and others,” according to a VA spokesman. “All of these providers must meet the education and practice requirements outlined in VA’s qualification standards for their profession.”

Not all of these will be full-time positions, however. While some will be full-time employees of the VA, others will be part-time, “depending on facility need,” the spokesman said. And the clinicians, regardless of their areas of expertise, will be part of interdisciplinary teams that will address a variety of conditions, including “post traumatic post-traumatic stress disorder, depression, alcohol and substance use disorders, anxiety disorders, and other support and readjustment issues,” the spokesman said.

He added that the Veterans Health Administration (VHA) offers training opportunities to help clinicians treat the kinds of issues most commonly experienced by veterans. “Many VA providers have completed a VA training program prior to their employment and they receive continuing education and training in addressing veterans’ issues through these programs,” he said. The VA also offers training in military and veteran culture for employees who want it.

The additional staff are meant to augment current services and increase access for veterans seeking mental health care, the VA spokesman said. Asked how many additional veterans will be able to get care as a result of the new hires, the spokesman said this depends on various factors, “including individual facility needs and the types of positions hired.”

The priority concern in hiring is in rapidly increasing access to outpatient treatment, said the spokesman, noting that facilities have been granted “discretion to hire additional staff for inpatient and residential treatment.” The Veterans’ Crisis line will gain 108 additional staff, and there are approximately 100 new positions being created to process Compensation and Pension examinations. These exams evaluate disability resulting from military service, determine its severity and, upon determination of a veteran’s eligibility, result in the offer of a payment or pension to the veteran.

The staffing level levels were calculated based on need by Veterans Integrated Service Networks (VISN), which takes into consideration the regional veteran population, that population’s mental health needs, and the range of mental health services already provided in the region, according to the VA. The VISNs offer care for a region, and are not necessarily tied to states.

Individuals interested in pursuing these new positions may apply after reviewing job postings at the VA Careers website (www.va.careers.va.gov) and at the USA Jobs website (www.usajobs.gov).