December 27, 2007 - —"This is going to be an emotional hearing."

With that statement, Rep. Bob Filner (D., Calif.), chair of the House Veterans Affairs (VA) Committee, opened a Dec. 12 hearing on what he and other legislators are calling an epidemic of suicides among veterans in the United States and their dissatisfaction with VA’s response.

"This is a topic," Rep. Filner said, "that the Department of Veterans Affairs and the American public don’t like to talk about."

However, in a marathon hearing held shortly before the holiday recess, a spotlight was focused on the topic, and a hearing that began with the story of one family’s struggle with their son’s suicide ended with Rep. Filner severely berating leading VA mental health officials.

Disputing The Numbers

Many times during the hearing, both legislators and VA officials stated that "the exact numbers should not matter" in a discussion of veteran suicide; that one suicide is one too many. Still, a lot of time was spent arguing over just how prevalent the problem is.

The hearing was prompted in part by a CBS news story in November on suicides in the veteran population that put last year’s number of veteran suicides at over 6,000. VA officials refuted that number, questioning its validity. But a VA Inspector General report released in May of 2007 found that as many as 5,000 veterans commit suicide a year—nearly 1,000 of whom are receiving VA care at the time.

VA had no numbers on the number of suicides among all veterans, but a preliminary evaluation performed by the agency on suicide rates among veterans returning from Iraq and Afghanistan shows that, from the beginning of operations in Afghanistan through the end of 2005, 144 known suicides were recorded among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans.

"This number translates into a rate that is not statistically different from the rate for age, sex, and race-matched individuals from the general population," Dr. Ira Katz, VA’s mental health chief, told Rep. Filner at the hearing.

Moreover, Dr. Katz said, VA studies show that combat deployment does not necessarily increase a veteran’s risk for suicide.

 "VA’s Epidemiology Service has published findings from a long-term, 20-year follow-up on the health of Vietnam-era veterans," Dr. Katz explained. "The peer-reviewed, published study reported that rates of suicide among veterans who were deployed to Southeast Asia did not differ statistically from veterans of the same era who were not deployed. A published study of veterans from the first Gulf War provided a similar finding."

Dr. Katz defended VA’s mental health treatment programs, stressing the agency’s efforts in suicide prevention.

"VA has a major suicide prevention program—the most comprehensive in the nation. The numbers aren’t the issue," Dr. Katz declared.

He noted VA’s creation of a suicide prevention hotline, which, in the five weeks from Oct. 7, 2007, to Nov. 10, 2007, logged 1,636 calls from veterans and 311 from family members. Those calls led to 363 referrals to suicide prevention coordinators and 93 rescues involving emergency services. Since the hotline began in July, there have been more than 6,000 calls and more than 300 rescues.

Asked if any of the veterans who called the hotline succeeded in committing suicide, Dr. Katz said he did not know, and that VA was in the process of doing follow-up on all those who have called.

And when asked if VA had enough resources for all of the suicide prevention and treatment efforts it would like to do, Dr. Katz answered in the affirmative, although admitted that there was still some question over what efforts work best and just how the money should be channeled.

"We really have extensive outreach," Dr. Katz said. "Is it enough to enroll every veteran? Is it enough to prevent every suicide? Apparently not. We have, thanks to you, considerable funds. And our challenge is to use these funds effectively."

Still, Rep. Filner took Dr. Katz and his colleagues to task for appearing before the committee with testimony that did not, in his opinion, address the veteran suicide problem. Dr. Katz defended his testimony as focusing on the existing treatment and prevention efforts that are proven effective.

"You’re delivering the message to America that there are major problems in VA treatment," Dr. Katz argued. "I want to deliver the message that care is available and treatment works. We have programs in place that can help people."

But, Rep. Filner accused VA of pointedly ignoring the statistics of veteran suicides and providing testimony filled with "sweetness and light."

"It’s analysis paralysis," Rep. Filner declared. "It’s just a bunch of data you’re going to throw out to us on this panel here and say you’ve done your duty. I want you to come back with a better report. This is not very useful."

Gaps In Education, Outreach

Anger directed at VA did not originate solely from legislators. Leading off the testimony at the Dec. 12 hearing were Mike and Kim Bowman, parents of Spc. Tim Bowman, USA, Illinois National Guard, 106th Calvary, who committed suicide in November 2005, eight months after returning home from Iraq. Asked what he thought of VA’s reaction to the CBS news report, namely of Dr. Katz’s appearance as a spokesman for VA on the program questioning CBS’s suicide rate calculation, Mike Bowman said, "My first reaction was to reach into the TV and wring his neck."

"Regardless of how perfectly accurate the numbers are, they obviously show a trend that desperately needs attention," Mike Bowman said. "The VA should have taken those numbers to Capitol Hill asking for more people, funding, and anything else they need to combat this epidemic. They should embrace this study as it reveals the scope of a huge problem, rather than complaining about its accuracy."

According to legislators, the Bowmans are the poster family for what problems are prevalent in the VA and military systems when it comes to the mental health concerns of returning veterans. Their testimony highlighted a number of gaps in service and planning that led directly or indirectly to their son’s suicide: poor reintegration processes for Reserve and National Guard units; nonexistent family education on post-traumatic stress disorder (PTSD); and an overwhelming sense among soldiers that to seek mental health care is not only a sign of weakness, but a sure-fire way to sabotage their career in the military.

"Family members of [my son’s unit] were given a 10-minute briefing on PTSD two months before the soldiers returned, and the soldiers were given even less," Mike Bowman told committee members.

Furthermore, the briefing was given during an hour-long meeting discussing insurance and pay issues, which seemed far more pressing matters at the time, he said.

"We, as National Guard families, were never educated on what to look for," Mike Bowman declared. "They gave us a magnet with a bunch of phone numbers on it and said, ‘Here, this is who you call for help.’"

Guardsmen were let off the bus and sent home and expected to reintegrate back into their old lives with no difficulty or assistance. Mike Bowman, now well-educated on PTSD, though too late, argued that, with the symptoms most frequently occurring within 90 days following redeployment, reservists and guardsmen should be called back for a 90 day follow-up evaluation.

"After they [return home], wait 90 days then bring them back," he pleaded. "Then bring them back in another 90 days. Then maybe stretch it out to six months. And make it mandatory. That means you’re going to have to pay them [to be there], but the price is small compared to the price paid by the families."

"And it has to be a real evaluation," he added. "Not a four-page test like the [post-deployment test] Tim filled out at Fort Carson. I’ve gotten that test. It’s a joke."

As for getting Guardsmen and Reservists enrolled in VA—a prerequisite for receiving VA health care—Mike Bowman wondered why VA was not making more of an effort at outreach.

"Why isn’t the VA there when they get home?" he asked. "You’ve got 118 guys getting off three buses. Why isn’t there someone from VA with a computer to register them before they go home? They’re just coming back from combat. You know they’re going to need help. Don’t make them come to VA. Have VA come to them."

Spc. Bowman never received care of any kind at VA prior to his death. However, shortly after, an appointment reminder came in the mail for him from VA. The appointment, made without his parents’ knowledge, was likely for follow-up surgical work on a hand injury received in Iraq, although VA would not release any details of the scheduled appointment to the Bowmans.

The Stigma Of Treatment

The Bowmans now serve as honorary parents to the other soldiers in Tim’s National Guard unit, providing those soldiers with advice and perspective from a family that’s still struggling with the effects of mental illness. According to Mike Bowman, members of Tim’s unit want to seek mental health care, but are reticent about coming to VA out of fear that news of their visit will eventually make its way to their commanders, throwing a monkey-wrench into any chances of promotion. Told by legislators that VA has a strict confidentiality policy regarding patient health information, Mike Bowman said it did not matter, that in small communities word would eventually get out.

Several soldiers in their son’s unit are seeking counseling privately, some going as far away as 100 miles so that there is little chance word will get back to their commanding officer, the Bowmans said. As long as mental health care and counseling is mandatory, it will remain stigmatized, with few soldiers stepping forward and saying they need help.

Mike Bowman said that, of VA’s counseling efforts, the Vet Centers should be the most effective, as long as counseling sessions are kept informal.

"Vet Centers were a great idea. Then VA came along and said that the Vet Centers needed to be manned by someone with a title and a suit," Mike Bowman said. "Now a veteran comes in and they’re immediately on the defensive. They’re not talking to a peer. They’re talking to someone a step above them. If you make a room with a couch and a pop machine and you fill it with soldiers—no one in uniform, nobody in a suit—those soldiers will open up."

What’s In A Name?

The one issue that everyone was able to agree on is that the word "disorder" has got to go.

"Why do they call it a disorder?" Mike Bowman asked. "‘Disorder’ implies ramifications that continue forever. It’s an injury. Just like getting shot. And with proper care, [it can be mended]."

The term post-traumatic stress disorder was coined in 1980, just as research into it was beginning in earnest on veterans of the Vietnam War. However, it’s not a term used universally, and its connotation as something that cannot be cured might be dissuading veterans from seeking help.

"We have to come up with better language," declared Rep. Steve Buyer (R., Ind.), ranking Republican member on the committee. "We’re going to work with the great minds of mental health to come up with that language."

"The Canadian government uses the term ‘operational stress injury.’ They don’t use PTSD. Would that be useful and helpful to us if we would turn to ‘operational stress injury’—another type of description that encourages veterans and soldiers to come in and discuss this without stigma?" Rep. Buyer asked Dr. Katz.

Dr. Katz said that, if the term ‘disorder’ is a deterrent to veterans seeking care, it should be changed. "In terms of what it’s called and how people react to that, the world’s experts are consumers and families. If they want to change the name, we should change the name," he said.