September 15, 2008 – A 24-year-old Iraq War veteran was growing increasingly upset about deductions on his pay check. He became more and more irate.
The woman distributing the checks didn’t know what to do, but she found Inda’vie Pugh, a Vietnam-era veteran.
Pugh put his hand on the young veteran’s hand and said, “Let’s talk.”
For the next two hours, they talked. The young veteran told Pugh about losing his family and wanting to give up.
Pugh got him to the right people for mental health support.
Now, the young veteran tells that story often in Vet to Vet meetings. That talk saved his life, he says.
The Vet to Vet program is a peer support program for veterans that is integrated into the services of the Central Alabama Veteran Health Care System, which has medical centers in Montgomery, Tuskegee and other clinics throughout the region.
Pugh went through the program when it started in February 2005. He is now a facilitator, who mentors and discusses a wide range of topics that affect veterans — relationships, medical conditions, military service, suicide, substance abuse, post traumatic stress and how to deal with those conditions.
This week was National Suicide Prevention Week and recently the Army released figures that show if the trend continues, the suicide rate for the Army could top that for civilians this year.
Last year, the Army had an all-time high of 115 suicides. If this year’s trend continues, the rate could exceed the 2007 rate of 18.1 suicides per 100,000. U.S. civilians in the same demographic commit suicide at a rate of 19.5 per 100,000.
Veterans also are taking their own lives at an alarming rate.
The most recent VA data from 2006 showed the highest number of suicides for veterans of Afghanistan and Iraq — 141 who left the military after Sept. 11, 2001, committed suicide from 2002 to 2005. The next year, another 113 committed suicide.
Although the numbers are not broken down by state, the central Alabama group reports five suicides since 2004. Those did not occur in CAVHS facilities, but the veterans were receiving care through the system.
The Vet to Vet program is designed to break through the stigma attached to asking for help regarding mental health issues and to combat the rising suicide rates by getting veterans the help they need.
The facilitators have been through the program and have gone through several months of training. They’re required to keep up their own treatment.
“They’re familiar with their own stressors and high risk factors and can help identify those in others,” said Dr. John Campbell, the acting chief of CAVHS Psychology Service. “Emotions change, different stressors can become more aggravated.”
The veteran facilitators also recognize when the level of care needs to change, he said.
Campbell recalled one facilitator who phoned a group member who seemed distressed at a meeting. During that phone conversation, the group member admitted having suicidal thoughts. The facilitator kept him on the line, got staff members involved and had him admitted to CAVHS within 20 minutes.
The veteran later told them the call was pivotal in getting him help and saved his life.
“He was comfortable saying that to another veteran,” Campbell said.
Pugh said the Vet to Vet program provides a comfortable environment for them to talk.
“Once they’re in a calm atmosphere they can tell us what’s going on in their lives and we can direct them to where they need to go,” he said. “We’ll let you talk all day if you want to talk.”
It took Pugh, a former Marine, 38 years to seek help for his mental health issues, but he’s realized it’s good work to help others and therapeutic for him as well.
It’s a mentorship environment and a natural extension of the military structure — trust is more easily built because of shared experiences.
“There’s an old saying in the military, ‘You can’t tell me how to get there if you ain’t been there,'” Pugh said.
Each facilitator has dealt with some sort of issues, physical or mental, that are likely service-related. They each have gone through the VA system for treatment. Other veterans look at that as a guide since the facilitators have done it and are continuing to do so. It signals that asking for help is OK.
Many younger veterans don’t want to come in for mental health appointments at all, let alone take off work for those appointments, Campbell said.
The Vet to Vet program helps ease that, as does training non-clinical and other staffers so that they recognize mental health issues when veterans come in for other appointments to help prevent more serious problems.
The Vet to Vet program offers nine meetings per week at three facilities — one in Montgomery, Tuskegee and Columbus, Ga. One of those groups is specifically for female veterans and has a female facilitator. If they aren’t comfortable with a mixed group, they have that option to meet with their peers.
Campbell and Pugh said interest is high, so they need to pace growth so facilitators don’t get burned out. They’re also trying to grow their own from the veterans in the program.
Currently, there are nine facilitators. Several are on leave, since they recognize they need time to take care of themselves in order to help others, Pugh said. The facilitators rotate between groups and facilities, to prevent them from taking ownership of a group.
“It’s not your group, it’s a Vet to Vet group,” Pugh said.
From October 2007 to August 2008, 320 groups met with 6,019 visits. That figure includes repeat participation. In October 2007, the average group attendance was 15. Last month, the average was 23.
Among women, there have been 163 visits as of August.
Only 0.3 percent of the Vet to Vet participants ask to see a staff member after the group meetings.
Sams said that’s an indicator that it’s working.
That kind of data doesn’t exist yet for the Operation S.A.V.E. program, which is an awareness program in place at most VA facilities nationwide, including in Montgomery, Tuskegee and Birmingham.
Sarah Robertson is the suicide prevention coordinator at the Birmingham VA Hospital. She said the program grew out of the Joshua Omvig Veteran Suicide Prevention Act of 2007, which required the VA to implement several things such as educating staff on suicide.
“Obviously not everyone is forthcoming with the fact that they’re suicidal,” Robertson said. “It’s increasing the employees’ own comfort level with suicide and talking about it so that they can work with someone that is suicidal.”
The training covers risk factors and warning signs as well. Robertson said white males over 40 are more likely to complete suicide. They also look out for those who have had a recent major loss, such as the death of a family member, physical loss, loss of health or employment. Substance abuse, mental illness and having family members that have completed suicide in the past are other risk factors, she said.
The VA also has created a suicide hotline that received 33,000 calls in the year that it’s been operational. Of those, more than 1,600 were considered rescues — when workers talked someone out of suicide or were otherwise able to intervene.
The increased attention to mental health also is reflected in staffing.
At the Birmingham VA, there were only 30 mental health professionals three years ago. Now there are closer to 130, said Jeff Hester, the hospital’s spokesman. A new mental health center also is in the works in Birmingham. He said the center is in the final design stages now and construction should begin next year on the hospital grounds.
But the clinical staff and veterans agree it doesn’t matter how they get there as long as they do.
“They will open up to us and we can take them to the right place and get them the help they need,” Pugh said. “And that’s the bottom line.”
