April 25, 2008 – That would seem like a really good idea after news broke last week that nearly 1,000 troops a month have attempted suicide after returning from service in Iraq and Afghanistan, according to internal VA e-mails, even though the department publicly acknowledged only 790 suicide attempts in all of 2007.
VA rolled out a pilot tracking system and suicide prevention database in 2005 to hospitals and clinicians in Colorado, Montana, Wyoming and Utah. But Dr. Michael Kussman, VA’s undersecretary for health, testified that the tracking system had not been deployed throughout the department as of the end of 2007. Kussman testified at a trial on a class action lawsuit alleging VA had covered up an “epidemic” of suicides.
The VA inspector general reported in May 2007 that this system was used on a limited basis and recommended its use throughout the department nationwide. Kussman, under questioning by Gordon Erspamer, an attorney representing the veterans groups suing VA, said as of 2007, 70 percent of the department’s medical facilities had not deployed the suicide tracking system. But, Kussman said, these facilities were told they needed to “move rapidly” to install the system.
Erspamer asked Kussman if he sent out a memo or directive that said, “Hey guys, 70 percent are not tracking, you have to start tracking now?”
Kussman answered, “I don’t recall if there is a specific memo to that effect.”
I have asked VA to provide me with details on the status of the tracking system, but have not received a reply.
A Hill staffer told me he believed that development of the suicide tracking system was still in its infancy, and he doubted it was in use throughout VA. This staffer said the status of the suicide tracking system will be a topic that the House Veterans Affairs Committee will address at a hearing it will hold on the “Truth About Veterans Suicides” on May 6.
Tracking Key to Suicide Prevention
That’s the view of Paul Sullivan, executive director of Veterans for Common Sense, which, along with Veterans United for Truth, filed the class action lawsuit now at trial in the U.S. District Court in San Francisco. Sullivan told me that such a system used nationwide would help VA better identify veterans who have symptoms and conditions that make them suicide risks, including –post-traumatic stress disorder and traumatic brain injury.
Based on the VA inspector general report, it seems widespread use of a suicide registry would definitely help identify veterans in need of immediate attention. The suicide registry piloted by VA in its facilities in the Rocky Mountain states showed that 20 percent of the veterans in the registry who attempted suicide had not been treated for mental health issues.
The suicide registry, the inspector general reported, is linked to the VA electronic health record system and can alert clinicians to put patients on heightened monitoring, but as of 2007, only veterans in a few states had the benefit of this increased monitoring.
Systemic Problems
Sullivan, a Gulf War veteran, said the slow and unresponsive VA system contributes to the despair that leads to suicide attempts. A veteran who has PTSD and traumatic brain injury, who also has lost his wife, children, home and job, and is living on the street, needs speedy help from VA, not a bureaucratic response that says wait in line for six months for a hospital or clinic appointment and years for your benefits.
I’m a Marine Corps Vietnam veteran and this whole scenario is sadly familiar, and I wonder why my fellow veterans from the current wars in Afghanistan and Iraq now have to suffer from the kind of neglect visited on Vietnam veterans.
Sullivan said that’s why he filed the lawsuit: He wants to ensure that all veterans receive the care and attention their service demands.
How About Using the Army/Defense System
The Army Behavioral Health Technology Office at the Madigan Army Medical Center in Tacoma, Wash., developed a couple of years ago the Army Suicide Event Report, a Web-based system that provides one location on the Internet for behavioral health providers to document detailed information relating to a suicide event.
This system has been adopted for use throughout the Defense Department, and maybe VA could use it. But that would probably require a multiyear, megamillion-dollar retooling effort by a contractor.
Madigan also developed the Automated Behavioral Health Clinic, another Web application that provides patients with touchscreen kiosks to answer questions on behavioral health issues that could help sound the alarm on potential suicides. VA might want to check this one out, too.
Health Data Repository Location Not a Big Secret
When I started covering Defense health IT five years ago, I was requested to never, ever disclose the location of the facility, which stores the health records of 9.2 million active-duty and retired service members and their families.
I have honored that request, even when contractors speaking at public forums give out the location. They need some open source intelligence education.
We have met the enemy, and he is us.
