“Veterans’ health care must also include the best mental health care. A shocking 20 veterans are committing suicide each and every day, especially our older veterans. This is a national tragedy that’s not talked about. The evidence shows that of veterans in the system receiving care, they are much less likely to take their own lives than veterans outside of this horrible, horrible and very unfair system.”

–Donald Trump, speech on veterans health care in Virginia Beach, July 11, 2016

Trump unveiled details of his plan to improve veterans health care during a speech in Virginia Beach, which has a large population of military members. He offered specific proposals, such as a 24-hour veterans hotline routed to the White House and increasing options for veterans to get treatment in the private market.

We’ll note that Trump’s veterans proposal on his website still carries the inaccurate, Three Pinocchio claim that “over 300,000 veterans died waiting for care.” We’ve written about this claim since September 2015, and have warned politicians from using it. It refers to the number of records in the Department of Veterans Affairs health-care database marked as “pending” for people who had already died.

But it’s impossible to know whether those veterans had died before or after the VA began its health-care enrollment system, or whether they had applied for health care. We urge the Trump campaign to correct this inaccuracy that has been on its website for the past eight months.

Trump’s claims about veterans’ suicides stood out to us, as the talking point is often misused by politicians. Trump said there are 20 veteran suicides a day, that suicides are more prevalent among older veterans, and that evidence shows veterans receiving care are less likely to commit suicide. To our delight, he accurately conveyed the 2014 preliminary findings from the most comprehensive study to date on veteran suicides — an issue that is often presented by politicians without context. Here are the facts.

The Facts

Suicide is a serious concern among veterans, and Americans at large.

The go-to figure used for veteran suicides has been 22 — that there are 22 veteran suicides a day. We’ve awarded Two Pinocchios to this claim in the past, when politicians use it with no context. But this widely cited statistic is a rough and outdated estimate based on partial data. It comes from the VA’s 2012 Suicide Data Report, which used death certificate data from fewer than half the states, and did not include some states with the largest veteran populations (such as Arizona, California, Texas and North Carolina).

Moreover, it was an estimate — researchers took the percentage of veteran deaths identified as suicides, out of all suicides from those states during 1999 to 2011. Then they applied that percentage to the number of suicides in the United States in a given year. That came out to 22 suicides a day.

But this figure, when used alone, has no context and says nothing useful about veteran suicides. It doesn’t tell you that suicide may be more or less common among certain veteran populations, how it compares to the civilian population, or any other important aspects of veteran suicides that should drive policymaking. Yet it’s used all the time and has become a symbol of its own; there’s even a movement to do 22 push-ups for 22 days (see: #22pushups) in honor of veterans who committed suicide.

Last week, the VA announced preliminary findings from its most comprehensive veteran suicide study to date. The VA worked with the Department of Defense and the Centers for Disease Control and Prevention for a study of veterans’ mortality records, for the first time piecing together 55 million veteran records over 35 years using military, health and mortality data. The full report is scheduled for release by the end of this month.

Researchers found that in 2014, an average of 20 veterans died from suicide a day. This is an actual count from veteran records collected from all 50 states. Among the suicides in 2014, 65 percent were of veterans 50 years and older. And researchers found that from 2001 to 2014, the rate of suicide among veterans who used VA services increased at 8.8 percent, compared to 38.6 percent among veterans who did not use VA services.

In his speech, Trump proposed increasing the number of mental health professionals within and outside of the VA system. He also said there should be more outreach to veterans who are not in the VA system but may need mental health care. He said improving mental health care for veterans should be a part of a nationwide effort, such as expanding the number of facilities, integrating mental health services with primary care, changing confinement rules and making it easier for family members to report warning signs.

Trump said veteran suicides are a “national tragedy,” so we looked at veteran suicides compared to civilian suicides. The VA’s previous studies had found that veterans in general have higher suicides rates than civilian populations, though the degree of difference varies for specific populations.

The new study has shown the same general trend; both male and female veterans had higher rates of suicides than their civilian counterparts. But the difference among male veterans and male civilians was greater than female veterans and female civilians, said Robert Bossarte, VA epidemiologist and researcher on both the 2012 and current studies.

Both veteran and civilian suicide rates have been on the rise. Adult civilian suicides increased 23 percent from 2001 to 2014, and veteran suicides increased 32 percent during that time, according to the study. A breakdown of the 2014 crude rates per 100,000 by age group is below (the civilian rates are lower than general population rates reported by CDC, as they do not include veterans):

Age Group Veteran suicides
(per 100,000)
Civilian suicides
(per 100,000)

While the 20-per-day figure is now updated, Bossarte again warned against simply using the figure as a talking point. The VA released the updated figure because of the public interest in the latest daily average, but Bossarte said he hopes that people also talk about the number in context when they use it.

“We understand, of course, that it’s become part of the narrative among veteran suicide and become a part of the national dialogue,” Bossarte said. “But once again, it’s not the most useful for understanding how things are changing over time. Within that straightforward number, you really can’t capture the complex changes” within the veteran population.

The Pinocchio Test

Trump said there are 20 veteran suicides a day, that suicides are more prevalent among older veterans, and that evidence shows veterans receiving care are less likely to commit suicide. He accurately cites the three points from 2014 results of the latest study on veteran suicides. His claim on solid ground because it adds context about suicides among older veterans and the difference in suicide rates among those who use VA services and those who don’t.

Even though the 20-per-day is the latest figure from 2014, we warn politicians from simply using it without context. We are eager to see the rest of the report’s findings from 35 years’ worth of data; this debate that has lacked comprehensive, data-driven facts.

The Geppetto Checkmark has been particularly elusive for Trump, who has earned one Geppetto Checkmark since he declared his candidacy in June 2015. But he got it right this time, so we will send off the presumptive Republican nominee to the Republican National Convention with the rare Geppetto Checkmark.

(To contact the VA’s Crisis Line: Call 1-800-273-8255 and push “1” for Veteran services. Veterans Chat can be accessed at www.VeteransCrisisLine.net. Veterans Text is available at 838255.)

The Geppetto Checkmark

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