I’ve said it in several of my previous videos,
but veteran suicide is an issue that’s very near and dear to my heart, and I mean it. I
said I would make a video on it eventually and in honor of Veteran’s Day, here it is.
I’ve already done the 22 pushups for 22 days challenge which is somehow supposed
to raise awareness for veteran suicide, but I don’t feel like that was quite enough.
So I’m gonna do it in my own special way – I’m going to strap my GoPro to my head and we’re
going to run 22 klicks or kilometers today. One for every single veteran whose life will be
taken by suicide today. I know I don’t look like a guy who can run 22 klicks in a day but trust
me, underneath all of this, there’s a runner. While doing that though, I’m going to talk to you
about veteran suicide. Some of this information is incredibly depressing. But hopefully by the end of
the video, you’ll have a greater understanding of the problem and maybe some ideas on how to fix
it. I’m focusing primarily on veteran suicide here because I believe it’s a huge problem,
please don’t take that to mean that I don’t care about civilian suicide. It’s just that…
well… I’m a veteran so I hope that makes sense. Anyway, let’s get this show on the road. Shall we? [Intro music] The recent conflicts in Iraq and Afghanistan
have brought veterans into the forefront of the American psyche in a way that hasn’t been seen
since the Vietnam War over thirty years ago. The American military has not been involved in
a long, protracted war in nearly a generation, and as was the case with many Vietnam
veterans, Iraq and Afghanistan veterans are facing many of the same mental health challenges.
Of all the statistics involving these veterans though, none are quite as shocking as their
rate of suicide. In 2012, 349 service-members chose to take their own lives, while only 295
of them were killed in combat related deaths. Suicide has been the leading cause of death
for veterans every year since. Currently, twenty-two veterans a day take their own lives.
This is triple the suicide rate for civilians. But war has been part of the human experience
since the agricultural revolution, so why are so many more veterans being impacted by it than
ever before? Why are so many of them choosing to end their own lives? What is it about modern
warfare that makes it so much more mentally dangerous than previous wars? And perhaps more
importantly, what are we doing wrong when it comes to mental health treatment and suicide prevention?
First, we have to look at the war itself. One of the most obvious differences, cited
by civilians and those in the media, is that there are no battle lines or fronts.
And the enemy isn’t wearing uniforms and they could be hiding anywhere, including among women
and children. This is a fairly new practice in warfare and is pretty unique to the experiences
of Vietnam, Iraq, and Afghanistan veterans. World War 2 veterans didn’t have to deal with
this so it’s definitely a cause of distress. But it’s hardly the only source. Perhaps to
their credit, World War 1 and 2 veterans weren’t too keen on killing each other. It’s estimated
that only 15-20% actually fired their weapons, and it’s since been reported that
many of them intentionally missed, firing over the heads of their enemies’, unless
there was a real threat. That all changed in Vietnam when the number became 85%. Vietnam is
also the war that started the PTSD epidemic. Perhaps it’s a good sign that we as humans
don’t necessarily like killing each other, even when we have to, and when we do, we are
affected by what psychologists call Moral Injury. If left untreated, these moral injuries can
lead to PTSD, depression, and suicidal ideation. On the flip side, on a more positive note,
far fewer soldiers are dying in combat than ever before. Massive improvements in vehicle and
personal protection, as well as advances in field medicine, have prevented countless deaths. On the
surface, this is a fantastic change that nobody could argue against. However, it is somewhat
of a double edged sword. Because it also means that more veterans are returning having survived
gruesome injuries that would have normally killed them, or having lived through more stressful
combat situations, or having witnessed traumatic events or injuries. Living through and seeing
all of that means that the Iraq and Afghanistan conflicts have created more than 250,000
veterans with Post Traumatic Stress Disorder. But it’s not just the way that these wars
are fought that has changed, the way that we conduct war in general is also a major source of
stress. Unlike the Civil War or World War 2, where soldiers were sent to the front until the job was
done, Iraq and Afghanistan veterans are sent on deployments of a predetermined length. Depending
on what branch the service member is a part of, these deployments could last anywhere from 6 to
18 months. Then they return home and they are expected to reintegrate into society, oftentimes
with the expectation of being redeployed a few months later. While suicide rates among non-combat
veterans are already high, it increases by 6% for every deployment the service-member is sent on.
Along with the multiple life interruptions and transitions in mindsets that these veterans must
endure, they are deprived of the one thing that could possibly give them closure – victory or
defeat. World War 2 veterans were there until the job was done and they came home to a victory day
ticker-tape parade. Iraq and Afghanistan veterans go to the other side of the world, do a job for a
predetermined amount of time, and then hand over the reins over to the next unit, they come home
without feeling like their mission was complete. Leaving many veterans wondering what they did any
of it for – what was the point of their sacrifice and the sacrifice of their fallen friends?
Operation Iraqi Freedom drew to a close in 2010, resulting in tens of thousands of veterans
returning home all at once. Do you remember what else was happening in 2010? The Great
Recession. At its peak in October 2010, the unemployment rate for all Americans was 10%.
For veterans it was double that at 21.1%. World War 1 and 2 invigorated the American economy –
veterans returning home easily reintegrated into the workforce and society at large. This was not
the case for Iraq and Afghanistan veterans – who, on top of normal job market issues, had to face
the stigma of mental health issues. Since 2010 things have slightly improved for veterans.
In 2014 veteran unemployment was only 31% higher than that of civilians. [Hydration noises. Big sigh.] There’s another difference about coming
home that’s unique to Iraq and Afghanistan veterans that wasn’t an issue for previous wars’
veterans – because it didn’t exist. While drugs, and particularly alcohol, have always been a
way for veterans to self-medicate and cope, prescription psychoactive medications have only
been on the market for the last three decades or so. Between 2005 and 2011, there was a
682% increase in prescription psychoactive medications for active-duty service-members.
Not veterans – active-duty service-members. The use of medication to treat mental illness
is controversial for the population at large, but there is a difference when it
comes to veterans specifically. [Gunfire] Making a transition from military
service to the civilian world is very difficult. I’d call it a transitional reaction, and
that reaction always involves stress, and that’s normal. But if you really want to
interfere with that transition, medicate ‘em. His opinion is that there’s a normal adjustment
which must be made with veterans who are returning home which mimics the symptoms of many mental
health disorders. And left alone, veterans may overcome that transition healthily. However, the
use of medication may add to, or simply mask, the underlying stress. Too often, veterans are
prescribed medication for what could be considered a normal reaction to an unusual life circumstance.
You may be thinking to yourself that the use of prescription drugs for mental illness has been
on the rise for the population as a whole, so of course it’s going to rise for veterans.
However it’s been rising for veterans at a much more alarming rate. Between 2005
and 2011, antipsychotic prescriptions, used to treat schizophrenia and dementia, have
risen by 22% among the civilian population. I’m going to give you a second to guess how
much they’ve risen in the military. No, higher. Okay are you ready? 1083%. I can tell you
with absolute certainty, that’s not because there are more veterans with schizophrenia
and dementia – these drugs are neural tranquilizers. And that’s not me putting a spin
on these, that’s literally what they’re called. Sedative anticonvulsant prescriptions, used to
treat seizures and epilepsy, have an off-label use as mood-stabilizers, and they’ve increased
by 94% for civilians and 996% for veterans. You can’t even get into the military if you have
epilepsy or seizures…. Or schizophrenia for that matter. Neither antipsychotics or anticonvulsants
are FDA approved to treat depression or PTSD, however they are often used in military and
veterans’ hospitals for that off-label purpose. Drugs that are approved for depression and PTSD
likewise have interesting numbers. Anti-anxiety medications such as benzodiazepines like
Valium have a high addiction potential but have seen a 713% rise. Opioids, used to treat
pain have likewise seen an astronomical rise. I discovered that veterans’ narcotic prescriptions
were being renewed, month after month, months on end, sometimes for one to two years, without an
examination of the body part that was in pain. I was ordered by supervisors to write
large amounts of schedule two narcotics for inappropriate medical circumstances. I
pointed out that 10 to 20% of opioid users become addicted. We were creating addicts.
Opioids, anticonvulsants, antipsychotics, and anti-anxiety medications are all fast
acting, taking only hours or even minutes to take effect and speaks to the military culture
of seeking the quickest, cheapest solution to a problem at the expense of long term side
effects. Antidepressants, such as SSRIs, are considered relatively safe and non-addictive
– and they’re the first-line treatment for mental illness in the civilian world, but they take
weeks to take effect. Which is probably why they’ve seen a 48% decrease in use in veterans.
Since the disproportionate rise in unorthodox medications has risen at the same time as
the disproportionate rise in veteran suicide, many have hypothesized these as a possible reason.
The top disclaimer on many of these drugs is that they may actually increase thoughts of suicide.
But veteran suicide has always been higher than it has been for civilians. In the year 2000,
before Iraq or Afghanistan, 28.6 out of every 100,000 veteran deaths were by suicide, compared
to 11.1 out of every 100,000 civilian deaths. But ten years later, well after Iraq and
Afghanistan had been underway for some time, that rose to 35.9 for veterans and only 12.4
for civilians. Making the veteran suicide rate three times that of the average person.
Even looking into the numbers for veterans themselves shows some surprising increases.
Between 2000 and 2010, male suicide increased by 15%, but increased by 35% for females. Firearms
are the preferred method of suicide for veterans, being involved in nearly two-thirds of them. While
women have traditionally preferred less violent methods, the use of firearms among women to
commit suicide has increased by 75% - while only increasing by 16% for men. This disproportionate
rise in the use of firearms for women is probably explained by the fact that women have been
receiving more extensive firearms training and have been assuming more combat roles.
Because of the nature of the job, veterans are more likely to be exposed to death than the
average person, but because of the high suicide rates, veterans are also far more likely to
personal know someone who has committed suicide. About half of all veterans personally know someone
who has taken their own life – and just that fact alone, knowing someone who has committed suicide,
makes them twice as likely to have depression and suicidal thoughts themselves. Veterans
exposed to traumatic death – whether combat or accident related – are four times more likely.
The Veterans’ Affairs hospitals are where most veterans go to get their care and they’ve have
had a notoriously bad reputation since their mishandling of Vietnam War veterans. Many veterans
are quick to share their nightmarish experiences with the system. But the primary complaint has
to do with getting into the system in the first place. Currently, it takes about 600 days once a
veteran applies to finally get accepted into the system. One-third of all veterans who apply
simply give up waiting and don’t follow up, and 900,000 veterans are still awaiting a
response. On a personal note, my experience with the VA has always been quick and courteous,
but I understand that I am in the minority. The bad reputation of the VA prior to 9/11 seems
to be reflected in the suicide rates as well. In the year 2000, among veterans who used the VA
system, 34.5 out of every 100,000 deaths were by suicide; while veterans who elected to use
civilian hospital systems only had 27.6. It seems the VA has improved its care and reputation
over the last decade however, as it’s flipped those numbers. Now, 27.6 out of 100,000 deaths
among VA users were by suicide, compared to 38.7 for those who were outside of the system.
On the surface, that may seem like a positive trend. But since veteran suicide is on the rise in
general, these numbers may reflect both positive changes in VA treatment and the inability
and eventual failure of veterans truly in need to become enrolled at all. Remember the
one third who simply give up and the nearly million who are still trying to get in?
Luckily, the VA is a centralized system that can track data on this demographic in ways
unseen in the civilian medical world. And looking at the treatment trajectories for veterans who
eventually attempt suicide, whether successfully or not, reveals some disturbing trends.
The majority of a veteran’s contact with the VA is through primary care, not mental health.
Of those with regular primary care appointments, slightly under half are even asked about mental
health or suicidal ideation. But perhaps more disturbingly, of the veterans who eventually do
commit suicide, 21% of them told their primary care team that they had suicidal thoughts
– and only 42% of those who report having those thoughts are referred to mental health.
Primary care doctors are far more often the last doctor a veteran will see before attempting
suicide. In only 8% of veteran suicides, a mental health professional was the last point of contact.
Two-thirds of veterans who commit suicide see a primary care provider at a VA facility within
thirty days of death. Half of those appointments were for routine medical examinations, but
one third of them were because the veteran reported having worsening suicidal thoughts.
Let me put that into perspective for you… Ten veterans with suicidal thoughts go in to
see their primary care doctor. Five of them are even asked about their mental health
status. Two of them report having suicidal ideation. And one of them might be sent to
mental health for a follow up. All ten of them will eventually kill themselves. Six of
them within the next thirty days. The other four will likely attempt within the next year.
Adherence to treatment is a major obstacle for veterans to overcome in preventing suicide.
Military culture often views seeing any kind of doctor as a sign of weakness, whether its
primary care or mental health. As a result, many veterans don’t follow up on treatment
or medication routines. Many veterans who eventually commit suicide often stop taking their
medications or refilling them at all. And counter to the popular stigma and widespread belief, only
13.6% of veterans who commit suicide have PTSD. Attempting suicide will often land a veteran in
an intensive in-patient treatment program. These can last several weeks or even months depending
on circumstances and diagnoses of the veteran. But treatments after these programs share many
commonalities. Of veterans who complete a program, 6% will reattempt within six months, and 15% will
reattempt within a year. Correlations between the post-program treatment of a veteran and suicide
reattempts show that the more frequent and intense the follow-up treatment, the more likely a veteran
is to reattempt. That doesn’t mean that getting further treatment from the VA causes suicidality
– it very likely means that the VA is aware that this person is more at risk and is trying harder
to get that person the care that they need. Veterans are a very different type of patient.
Many would describe themselves as stubborn or bull-headed, and having been indoctrinated by
military culture into thinking that seeking help is a sign of weakness, many won’t ask for
help until they are in very dire need. Which is a major misunderstanding for caregivers who
are only used to treating civilians. By the time a veteran finally reports having suicidal
thoughts or intentions, they are MUCH further down the road than a civilian would be. By
the time a veteran finally asks for help, they have been suffering for far longer.
And there needs to be much more awareness of this fact in the veteran healthcare system. But what else can be done to prevent veteran suicide? Medication is a useful tool but it's
clearly been over-used in the veteran community, and the right medications and therapies are
being ignored in favor of quick fixes that turn people into self-described zombies. There’s
been little research done on antiphychotics and anticonvulsants on eventual suicide – I’m sure
you can put on your tinfoil hats and imagine why. But really, the best thing that can be done
is helping them reintegrate into society. Hire veterans – they want jobs, not handouts. They
need that sense of purpose again. They also need a sense of belonging. If you know a veteran in
your community, invite them out to neighborhood events and make them feel more involved.
You might have to try a few times given how stubborn some of us can be. But I assure you, by
doing the opposite and leaving the quiet lonely veteran alone, will only make things worse.
I would be telling the veterans out there that they’re the ones who need to open up
and reach out. But being a veteran myself I know how it is. We’re stubborn. We’re not the
ones who need to change, it’s everyone else. So as a message to everyone else. The saying is
you can lead a horse to water, but you can’t make him drink. Well, find a veteran and lead them
to water. Invite them to a neighborhood event or neighborhood gathering. Make them feel like they
belong. Because now that you know more about what we go through once we get home, you know better.
Hey guys if you enjoyed that video or you learned something, make sure to give that like button
a click. If you’d like to see more from me, I put out new videos every weekend, so go ahead
and give that subscribe button some help. With it being veterans day, make sure to help spread this
information by sharing it on Reddit, Facebook, and Twitter – and while you’re there make sure to
follow my accounts. Let’s see if we can’t lower that number so I don’t have to run so much next
year. But in the meantime, if you’d like to watch one of my older videos, how about this one? [Outro Music]
