November 20, 2011 (New York Times) – I began my psychiatry residency at a community mental health center. The director liked to put trainees in their place. He’d trade any of us, he said, for a good employment counselor. Medication and psychotherapy were fine, but they worked better if a patient had a job.
Suicide is a distinctive event, but its causes are hardly simple or single. Mental illness plays a role — mania, depression, schizophrenia and, in veterans especially, post-traumatic stress disorder. Brain injuries of the sort that are common in our current wars increase the risk of suicide by half.
As a result, mental health services are central to any program to prevent suicide. Psychotherapy and medication have been shown to help with each of the disorders that can lead to suicide. The recent report by the Center for a New American Security suggests that too few mental health professionals are available to veterans. Where staffing levels improve, suicide rates decrease.
It has been decades since I routinely treated veterans, so I hardly put myself forth as an expert, and the center’s report strikes me as comprehensive. I would point only to this omission: a lack of emphasis on the need for dignified work.
Study after study correlates unemployment with suicidality. While joblessness among veterans is not uniformly high, for some groups the numbers are astronomical. Nearly 27 percent of male veterans 18 to 24 are unemployed. When soldiers leave the military, they lose what service provides: purpose, focus, achievement, responsibility and the factor the CNAS report calls “belongingness.” The workplace can be stressful, but especially for the mentally vulnerable, there is no substitute for what jobs offer in the way of structure, support and meaning.
The jobs bill working its way through Congress — which would give businesses tax credits for hiring veterans, especially those with service-related disabilities — is a step in the right direction. More broadly, for the Department of Veterans Affairs, a successful employment program would act as a mental health program. I should add that the same is true for the country in general.