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VA suicide hotline still plagued with problems, IG finds

Despite change in leadership and promises to address ongoing problems with its veteran suicide line, nearly 30 percent of calls to the Department of Veterans Affairs were redirected to outside emergency centers, according to an inspector general report released Monday.

“We found that [Veterans Crisis Line] staff did not respond adequately to a veteran’s urgent needs during multiple calls to the VCL and its backup call centers,” the report said.

When the VCL program was started in 2007, VA management initially estimated that approximately 10 percent of calls would be rolled over to a backup center.

In fact, call rollover to backup centers increased between April and November 2016, peaking at more than 108,000, or a 28.4 percent rate.

In November, calls to the backup centers hit a peak of nearly 18,000 – a nearly 35 percent rollover rate.

In February 2016, the IG issued a report detailing how some suicide calls were being sent to voicemail or callers did not always receive immediate assistance from VCL and/or backup center staff.

The IG then called for the department to implement seven separate recommendations, but as of December 16, 2016 none were in place, Monday’s report said.

House Committee on Veterans’ Affairs Chairman Phil Roe, M.D. (R-Tenn.) expressed frustration, saying it is “unacceptable that issues with the Veterans Crisis Line have still not been addressed.”

Communications Director Tiffany McGuffee Haverly told Fox News the committee will hold a hearing April 4 to examine ongoing issues with the Veterans Crisis Line.

Sen. Johnny Isakson, R-Ga., chairman of the Senate Committee on Veterans’ Affairs, echoed Roe’s reaction to the IG report.

“The findings in this latest report identify an unacceptable disconnect between the Clinical Advisory Board and the Veterans Crisis Line in obtaining the clinical input necessary to make policy decisions. The Veterans Crisis Line should be collaborating with clinical services every step of the way,” he said in a statement.

Amanda Maddox, spokesperson for Isakson, told Fox News the committee was “informed by the inspector general that they do not believe there is a need for legislation. Our committee is currently looking into additional oversight options as well.

The IG also reported that management had not set any standards for the length of wait times when a veteran calls.

“We found that VCL leadership had not established expectations or targets for queued call times or thresholds for taking action on queue times. A veteran could be queued for 30 minutes, for example, and that wait time might not be reflected in hold time data; however, the result of the delay is the same, whether the veteran was in a queue or on hold,” the IG said.

The IG also criticized the absence of sustained and permanent leadership at the VCL, which functioned without a director for 10 months in 2015 before a permanent replacement was named.

But that director resigned in June 2016 and as of December 2016, no permanent director has been hired. Furthermore, supervisory staff did not identify the deficiencies in their internal review of the matter.

Detailed study confirms high suicide rate among recent veterans

Recent veterans have committed suicide at a much higher rate than people who never served in the military, according to a new analysis that provides the most thorough accounting so far of the problem.

The rate was slightly higher among veterans who never deployed to Afghanistan or Iraq, suggesting that the causes extend beyond the trauma of war.

“People’s natural instinct is to explain military suicide by the war-is-hell theory of the world,” said Michael Schoenbaum, an epidemiologist and military suicide expert at the National Institute of Mental Health who was not involved in the study. “But it’s more complicated.”

The study brings precision to a question that has never been definitively answered: the actual number of suicides since the start of the recent wars.

Though past research has also found elevated suicide rates, those results were estimates based on smaller samples and less reliable methods to identify veteran deaths. The government has not systematically tracked service members after they leave the military.

“People’s natural instinct is to explain military suicide by the war-is-hell theory of the world. But it’s more complicated.”
— Michael Schoenbaum, an epidemiologist and military suicide expert at the National Institute of Mental Health

The new analysis, which will be published in the February issue of the Annals of Epidemiology, included all 1,282,074 veterans who served in active-duty units between 2001 and 2007 and left the military during that period.

The analysis matched military records with the National Death Index, which collects data on every U.S. death. It tracked the veterans after service until the end of the 2009, finding a total of 1,868 suicides.

That equates to an annual suicide rate of 29.5 per 100,000 veterans, or roughly 50% higher than the rate among other civilians with similar demographic characteristics.

The issue of veteran suicide has become a political cause for activists and legislators. One statistic has become a rallying cry: 22 veterans take their own lives each day.

That figure is a national estimate based on a Department of Veterans Affairs analysis of death records from 21 states. Though it is usually cited in the context of the recent wars, most of those suicides involved older veterans, who account for the vast majority of the nation’s 22 million former service members.

Among veterans in the current study, there was one suicide a day.

The rates were highest during the first three years out of the military.

Veterans who had been enlisted in the rank-and-file committed suicide at nearly twice the rate of former officers. Keeping with patterns in the general population, being white, unmarried and male were also risk factors.

Men accounted for 83% of the veterans in the study and all but 124 of the suicides. They were three times more likely than women to take their own lives.

Female veterans, however, killed themselves at more than twice the rate of other women — a difference much bigger than the gap between male veterans and non-veterans.

A likely explanation is that women with military experience are much more likely than other women to attempt suicide with firearms, dramatically increasing the likelihood of death, said Mark Kaplan, an epidemiologist and suicide expert at UCLA.

Overall, the suicide rates for recent veterans set them apart from veterans of past generations.

In the Vietnam era, suicide rates were elevated for veterans suffering from post-traumatic stress or those wounded in action. But on the whole, suicide rates for veterans in their first few years out of the military were lower than in the general population, according to research.

The elevated rate today could reflect differences in who served, the study’s authors speculate. In the days of the draft, troops represented a wider cross-section of society. The long wars in Afghanistan and Iraq may have attracted more volunteers prone to risk-taking and impulsive behaviors.

“We don’t have the data to know,” said Tim Bullman, a mortality expert and health statistician at the VA and coauthor of the paper.

Another possibility, he said, is that a weak economy during the recent wars made the transition to civilian life more difficult.

More puzzling is the suicide rate for veterans who never went to Afghanistan or Iraq. It was 16% higher than for those who did.

Bullman said one reason could be that service members with psychological problems were often held back from deployment. He added that that suicide prevention efforts had focused on service members and veterans who did go to war.

Experts have also suggested that the military may have become a less forgiving and nurturing place over the course of the wars. “The stresses are not limited to the individuals who are sent to war,” Schoenbaum said.

A more detailed accounting of veteran mortality is on the horizon. A massive new data trove is being assembled by the Pentagon and the VA. Known as the Suicide Data Repository, it links national death records to military and healthcare data.

Among veterans who have served since 1974, the project has identified more than 2 million deaths of all types between 1979 and 2011, according to Robert Bossarte, a VA epidemiologist helping oversee the effort.

For each death, researchers will be able to learn the veteran’s deployment history, education and other information.

Researchers plan to build on the current study — which does not include reservists or veterans who served after 2007 — and look at suicide rates for all 3.7 million veterans who served since 2001.

How many women Veterans have PTSD?

Among women Veterans of the conflicts in Iraq and Afghanistan, almost 20 of every 100 (or 20%) have been diagnosed with PTSD. We also know the rates of PTSD in women Vietnam Veterans. An important study found that about 27 of every 100 female Vietnam Veterans (or 27%) suffered from PTSD sometime during their postwar lives. To compare, in men who served in Vietnam, about 31 of every 100 (or 31%) developed PTSD in their lifetime.

Veteran’s Fact Sheet

Veteran’s Fact Sheet

A General’s New Mission: Leading a Charge Against PTSD

Brig. Gen. Donald C. Bolduc, commander of American Special Operations Forces in Africa, tells soldiers that it is all right to get help for brain injuries and mental health problems. CreditAndrew Harnik/Associated Press

STUTTGART, Germany — It might have been the 2,000-pound bomb that dropped near him in Afghanistan, killing several comrades. Or maybe it was the helicopter crash he managed to survive. It could have been the battlefield explosions that detonated all around him over eight combat tours.

Whatever the cause, the symptoms were clear. Brig. Gen. Donald C. Bolduc suffered frequent headaches. He was moody. He could not sleep. He was out of sorts; even his balance was off. He realized it every time he walked down the street holding hands with his wife, Sharon, leaning into her just a little too close.

Despite all the signs of post-traumatic stress disorder, it took 12 years from his first battlefield trauma for him to seek care. After all, he thought, he was a Green Beret in the Army’s Special Forces. He needed to be tough.

General Bolduc learned that not only did he suffer from PTSD, but he also had a bullet-size spot on his brain, an injury probably dating to his helicopter crash in Afghanistan in 2005.

Now, after three years of treatment, General Bolduc is doing better. And, in his role as commander of American Special Operations Forces in Africa, he has become an evangelist for letting soldiers know that it is all right to get help for brain injuries and mental health problems.

“I’ve really seen a difference in myself,” General Bolduc, 54, said. “There are still the nonbelievers. We’ve got to get to them.”

That means changing attitudes that equate mental illness with weakness. Donald J. Trump, the Republican presidential candidate,said in a speech this week that some veterans returning from war “can’t handle” the stress. Mr. Trump was arguing for mental health services, but the remark drew scorn from veterans’ groups that work to reduce the stigma. Mr. Trump’s campaign has said his remarks were taken out of context. A spokesman for General Bolduc declined to comment.

On a recent afternoon, General Bolduc, his starched uniform weighed down by a giant patch of colorful ribbons and medals across his chest, stood ramrod straight at the Stuttgart headquarters from which he commands Special Operations fighters battling the Islamic State, Boko Haram, the Shabab and other terrorist groups in Africa, and he declared, “I’m in counseling.”

General Bolduc wants soldiers under his command — who are stationed in some of the continent’s most difficult parts — to know that seeking help will not hurt their careers. In his opinion, PTSD is the same as a broken arm.

“The powerful thing is that I can use myself as an example,” General Bolduc said. “And thank goodness not everybody can do that. But I’m able to do it, so that has some sort of different type of credibility to it.”

Other high-ranking officers have come forward to talk about their struggles with post-combat stress and brain injuries. And in recent years, Special Operations commanders have become more open about urging their soldiers to get treatment.

Gen. Joseph L. Votel, then the head of the United States Special Operations Command, spoke to CNN last spring about ending the stigma tied to seeking treatment. “It is absolutely normal and expected that you will ask for help,” he said.

The stigma can be particularly acute in specialized military units, like the Green Berets and the Navy SEALs, that are trained for the toughest assignments and consider intervention a sign of weakness.
Yet the Department of Defense estimates that almost a quarter of all injuries suffered in the conflicts in Afghanistan and Iraq were brain injuries. As many as 20 percent of veterans of those two conflicts experience PTSD.

Traumatic brain injuries and PTSD share symptoms like headaches, depression and, sometimes, suicidal behavior. The consequences of not getting help can be severe: In the past four years, more than 2,000 active and reserve military personnel have killed themselves, according to the department.

Across the military base in Stuttgart, suicide prevention and PTSD brochures are positioned on desktops and hallway tables. The base has a Preservation of the Force and Family center, a program created specifically for Special Operations Forces, where anyone can seek help for behavioral issues, including alcohol or drug abuse, and counseling for family and financial problems.

When commanders rented a movie theater last year for a screening of the latest “Star Wars” movie, General Bolduc made sure that the free tickets had to be picked up at the center, to get soldiers comfortable with stepping inside the door.

On base, officers talk openly about mood swings, making their wives cry and other indicators that led them to seek help.

General Bolduc, who took command in April 2015, encourages these kinds of honest conversations. In speeches to his leadership team and in visits to his troops in Africa, and every time a new soldier comes into his fold, he tells his personal story and urges anyone experiencing the same kinds of symptoms to get help.

A native of Laconia, N.H., General Bolduc said he had wanted to join the Special Forces ever since as a young boy he watched the movie “The Green Berets” with his grandfather.

“For all Bolduc males, service to country is a requirement,” said General Bolduc, whose two brothers also joined the Special Forces. “My grandfather didn’t care what service, but he did feel that it was an obligation.”

He earned his ROTC commission in 1989, graduating from Salem State College in Massachusetts, and later earned a master’s degree in security technologies from the United States Army War College.

Last month, General Bolduc awarded a Purple Heart to an airman 11 years after he had received a brain injury during a mortar attack in Iraq. The airman, Tech. Sgt. David Nafe, had experienced memory loss and migraines for years.

General Bolduc made a fuss, summoning his staff to a ceremony for the award. The military publication Stars and Stripes published an articleabout Sergeant Nafe on its front page. In front of the audience gathered for the ceremony, the general told the soldier he could relate to him.

“When people look at you, you look completely normal,” General Bolduc said. “And then they see how you act and they say, ‘God bless, what’s wrong with that guy?’ ”

The Defense Department and the Veterans Health Administration have worked to improve mental health services. Yet many service members do not regularly seek care, according to a 2014 report from the RAND Corporation, a think thank that conducts government studies.

That procrastination is exacerbated by the hypermacho culture of Special Operations, General Bolduc said, where high-stress tours leave members especially vulnerable. Members wait an average of 13 years and 3 months to seek treatment for injuries that are not catastrophic, according to Sarah McNary, a nurse in charge of traumatic brain injury cases at Landstuhl Regional Medical Center in Germany, who first persuaded General Bolduc to submit to a brain examination.

When a bomb dropped on his position in Afghanistan in 2001 — a friendly fire accident — General Bolduc’s hip was badly damaged. He declined medical treatment and pushed ahead with the mission, an offensive on Kandahar, and later needed hip-replacement surgery.

An average-size man at 5-foot-7 and 145 pounds, General Bolduc is so fit and focused that even if he were wearing overalls he would probably be identifiable as a Green Beret. Yet he has a soft side, offering a handshake or a hug to everyone he meets on a stroll around the base.

“He’s Captain America,” said Lt. Col. Nathan Broshear, a spokesman for Special Operations Command Africa.

Now, the general goes to counseling sessions with his wife, who for years urged him to seek treatment.

“The doctors love it because I’m still guarded,” he said. “First of all, you feel funny even talking about it. You’re not likely to give them your real symptoms. But your wife is going to say, ‘That’s a load of crap.’ ”

About a month ago, while visiting a team under his command, General Bolduc asked how many of the men had been close to blasts, bombs and mortar shells. Everyone raised a hand.

“Then I said, ‘How many of you have sought treatment?’ ” he said. “No one’s hand went up.”

General Bolduc told them his own story, and afterward, all of the men decided to get exams. Doctors found a tumor in one soldier’s brain.

He was flown to Walter Reed National Military Medical Center, near Washington, where he is being evaluated.

SLEEP PROBLEMS PERSIST AFTER PTSD TREATMENT, STUDY OF ACTIVE TROOPS FINDS

BY BRET MOORE,DEC 9, 2016
Sleep disturbance is one of the most common issues individuals with PTSD face. Specifically, insomnia and nightmares plague the vast majority of those struggling with the disorder. 

Although it is assumed to be high, relatively little is known about the actual prevalence of sleep disturbances in veterans with PTSD. Any clinician who treats veterans with PTSD will likely tell you that most, if not all, of their patients suffer from sleep problems to some degree. 

Relatedly, it is assumed that sleep disturbances improve with evidence-based PTSD treatments. However, to what degree is unclear.  

In an effort to gain better clarity on these issues, researchers from the University of Texas Health Science Center at San Antonio, and colleagues from several other prestigious academic institutions, asked these questions to over 100 active-duty service members. Their findings were published in the November issue of Psychological Trauma and were shocking. 

Not surprisingly, insomnia was the most frequently reported PTSD symptom prior to treatment. A whopping 92 percent acknowledged some degree of difficulty falling or staying asleep. Although not as high as insomnia, 69 percent of the same group reported suffering from nightmares. 

The surprising, and somewhat disheartening news, is that approximately three-fourths of service members still reported insomnia as a problem after PTSD treatment.  And around half still struggled with nightmares. 

The researchers took an even deeper look into the results and found additional important information. For those service members who no longer met criteria for PTSD after successful treatment, more than half continued to report insomnia, and 13 percent continued to report problems with nightmares. Again, this is from those troops who made such significant improvement that they no longer had enough symptoms to retain the PTSD diagnosis. 

In my opinion, there are two important take-home messages from this study. 

First, sleep problems will likely continue in many people with PTSD, even in those service members who benefit greatly from treatment. Therefore, it is important to manage expectations. There are few — if any — complete “cures” in psychology and psychiatry, but this doesn’t mean you can’t go on to lead a rewarding and fulfilling life. Keep in mind, many people without PTSD struggle with sleep. 

Second, you may want to ask to be referred for a sleep-focused therapy in addition to the PTSD treatment. Treatments like Imagery Rehearsal Therapy and Cognitive-Behavioral Therapy for Insomnia have been proven successful for nightmares and insomnia. 

Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance. 

Duke Study Shows Therapy Effective For Military Sufferers Of PTSD

(RALEIGH (NC) NEWS & OBSERVER 28 NOV 16) … Gavin Stone

DURHAM – A well-known treatment for post-traumatic stress disorder in civilians significantly reduced PTSD symptoms in active-duty military personnel who took part in a study published last week by the Duke University School of Medicine.
The study, in the journal JAMA Psychiatry, is the largest randomized clinical trial to date to apply cognitive processing therapy, or CPT, which has been used among civilians for decades, to active-military patients who are suffering from PTSD. It found that while using the treatment in both group and individual sessions significantly reduced PTSD symptoms, individual treatment was nearly twice as effective.
The study divided 268 participants from the U.S. Army’s Fort Hood in Killeen, Texas, into two groups, one that would receive the individualized CPT, while the other half participated in group CPT sessions. While both groups showed significant improvement to their mental health over the course of 12 sessions, close to 50 percent of participants who were given individual CPT were able to progress to a point where they were no longer medically classified as suffering from PTSD. About 37 percent of the participants in the group sessions progressed to this point.
CPT is a method of treatment that involves evaluating the thoughts and beliefs associated with a patient’s traumatic experience, which for many in the military involves blaming themselves for events in combat that are out of their control, according to Patricia Resick, a professor of psychiatry and behavioral sciences at the Duke University School of Medicine and lead author of the study.
Resick said that this tendency comes from the belief that in a “just world” good things happen to good people, which for some could also mean that if something bad happens it’s because you’re a bad person.
“Instead of looking to the perpetrator of the trauma, they look to themselves to assign blame,” Resick said. “What we do is we systematically lead them through a series of steps to teach them to ask themselves questions so they can make more balanced statements about themselves.”
Resick developed CPT in the 1980s to treat victims of rape and other interpersonal trauma. But the treatment was not applied to combat-related PTSD and related conditions in military personnel and veterans until 2008 when the U.S. Departments of Defense and Veterans Affairs formed a national research consortium called STRONG STAR to study methods of detection, prevention, diagnosis, and treatment of the disorder.
Lt. Col. Alan Peterson, director of the STRONG STAR Consortium and professor of psychiatry at the University of Texas Health Science Center San Antonio, said civilian research groups had not tested CPT on military personnel because they had a difficult time modifying their treatments to meet the needs of those who have been in combat.
Peterson said that getting treatment for PTSD carries a stigma of weakness that can prevent patients from seeking it out, or even acknowledging that there is a problem.
“Sometimes they would rather deploy and walk across a mine field than sit down and tell someone what happened to them,” Peterson said. “If we called it the ‘PTSD Consortium,’ then no one would come in.”
Peterson said that the most important outcome of the study for him was that PTSD treatment need only last months, not a lifetime.
“Without the proper type of treatment, yes, people can suffer for a lifetime,” Peterson said. “That’s what we’re trying to correct.”
There are many ways to cope with PTSD, Peterson said, such as using service dogs, going hiking or on camping retreats, rafting, music, art and yoga, but these things do not get at the root cause of the patient’s PTSD.
“Part of what causes PTSD is there’s one or more really horrible events that have occurred, and you need to drill down on the thoughts and memories that go with that,” Peterson said. “CPT drills down on the beliefs the people have about themselves and the world and the future.”
Peterson said the Duke study has already spawned five new clinical trials which will seek to determine whether more individualized treatment plans than the standard 12-session model will be more effective in reaching those with more complex cases of PTSD who were part of the 50 percent that showed slower progress.
http://www.newsobserver.com/news/local/counties/durham-county/article117505033.html

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