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PTSD and Preventing Veteran Suicides

Dr. Mark Kaplan
Suicide Prevention Action Network
Monday, November 12, 2007 1:00 PM

Dr. Mark Kaplan, professor of community health at Portland State University and author of the recent article "Suicide Among Male Veterans: A Prospective Population-Based Study," will be online Monday, Nov. 12 at 2 p.m. ET to discuss Post Traumatic Stress Disorder, suicide risks among veterans and what can be done to mitigate them. Click here to read his recent testimony before Congress on the subject.

Submit your questions and comments before or during the discussion.

Kaplan is professor of community health at Portland State University and holds adjunct appointments in psychiatry and family medicine at the Oregon Health and Science University, and epidemiology and community medicine at the University of Ottawa. He was 2004 Fulbright Scholar in Canada. He is a member of the Suicide Prevention Action Network USA National Scientific Advisory Council.

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Camp Pendleton, Calif.: I tried to kill myself in 2004 while serving on active duty. In the hospital, I met many others who also had attempted suicide while on active duty.

After an active duty member attempts suicide, in your opinion, is it ethical, wise or effective to send them back to work in the same capacity prior to their suicide attempt?

If the screening of incoming military folks is supposed to create a group of "the best of the best" according to the high standards of getting into the military, how can one explain the higher rates of suicide? In your opinion, what is causing so many military folks -- people who are supposed to be more physically and emotionally tough than the average population -- to want to die?

Do you believe the military has been negligent in its mental health programs and preventitive efforts? And do you believe top military doctors should be charged with crimes or otherwise held accountable for the failures to provide for the mental health of military members? Do you believe the Department of Defense has conspired to obscure the actual numbers of suicides, attempted suicides, and suicide gestures?

Thanks you for your work in this area. I know I have saved a few lives just by chance meetings with suicidal veterans ... I am sure your work has saved many times more than that. Thanks.

Dr. Mark Kaplan: Thank you for your questions. Obviously, it would be professionally unethical to send back to work military personnel who have serious psychiatric conditions. As you correctly note, incoming personnel are screened, but some are slipping through the cracks. There is evidence in the scientific literature that a majority of individuals (in the general population) who die of suicide had contact with health care before their suicide.

A suicide prevention program adopted by the Air Force may serve as a model for other branches of the military. The program involves a community approach to suicide prevention.

As for your last question, under the current conditions (with limited resources), the military doctors are probably doing their best. According to a recent Petagon report, the military health care system is overburdened with military personnel who are returning home with PTSD and other psychiatric conditions.

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Clarksville, Tenn.: Do you think the issue of PTSD/suicide will become a national crisis? The Army does not really seem to believe in PTSD and merely "chapters" a lot of these soldiers out of the service without any treatment.

Dr. Mark Kaplan: Although the focus has been on PTSD, other psychiatric problems are also important risk factors for suicidal behavior.

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Virginia: While Republican presidents go to war more often than Democratic presidents, President Clinton increased deployments more while he cut the defense budget by 60 percent. Suicide was much higher during his eight-year term than with President Bush, who increased the defense budget by something like 200 percent.

Dr. Mark Kaplan: Thanks for your question. The suicide rate for the country as a whole declined during Presdent Clinton's two terms.

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New York: We are learning of many of the difficulties that returning Iraqi War veterans have. What are your concerns about their long-term health issues?

Dr. Mark Kaplan: Excellent question. The focus so far has been on the immediate impact of the war. The hidden psychological injuries of war are very hard to document. We know that many WWII veterans still experience the trauma of war.

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Washington: I appreciate you taking time out to discuss the important issue of veterans mental health today on Veterans Day. My question is, how are the military and government working to help veterans with PTSD? Are there adequate programs that help prevent suicide?

Dr. Mark Kaplan: The Department of Veterans Affairs (VA) recently started a national suicide prevention hotline. To operate the national hotline, VA is partnering with the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services (HHS) and the National Suicide Prevention Lifeline. Veterans can call 1-800-273-TALK (8255) and press "1" to reach the VA hotline, which will be staffed by mental health professionals in Canandaigua, N.Y. who will work closely with local VA mental health providers to help callers.

Furthermore, the President recently signed the Joshua Omvig Veteran Suicide Prevention Act (Public Law 110-110). The Joshua Omvig Veterans Suicide Prevention Act is named for Joshua Omvig, a 22 year-old soldier who took his own life in 2005 after an 11-month deployment to Iraq. The legislation directs the federal government to develop a comprehensive program aimed at reducing suicide among veterans. Mandatory training for Veterans Affairs staff would be put in place, and veterans would be offered mental health screening and referrals, at their request, for counseling and treatment.

Mental health care would be available on a 24-hour basis, including a toll-free hot line, and additional research would be conducted into suicide prevention among veterans, including those who have experienced sexual trauma in the service. Family outreach and peer counseling is encouraged under the legislation, with an emphasis on removing the stigma associated with mental illness and promoting skills for veterans in dealing with mental illness.

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