Director, National Suicide Prevention Lifeline

April 2010

 In my 30 years of working in the field of mental health, I have heard a number of things from various veterans I encountered about the care they had received in the VA’s health and mental health systems.  I can’t recall a lot of good things being said.  Surely it wasn’t all bad, but I used to hear a lot about red tape, bureaucracy and sometimes, complaints about VA workers who didn’t really seem to care.  It seemed that the negative perceptions of a good number of veterans about the VA’s health and mental health services were as immovable and unchanging as the “VA bureaucracy” itself.

As the Director of the National Suicide Prevention Lifeline, I can’t say I know much about the VA’s health services.  But I do have knowledge of the VA’s suicide prevention services—particularly their hotline—and it’s hard not to be impressed.  After the VA invested millions to support their suicide prevention programming beginning in late 2006, it has become clear that the VA has changed for the better in helping suicidal vets.  Perhaps even more remarkable is this: some of the VA approaches are unprecedented in the field of suicide prevention. How is it possible that a federal agency once known for its bureaucratic ways has become a leader in innovative practices in suicide prevention? 

There has been a lot of media attention devoted to concerns about suicide among U.S. military veterans.  With some national estimates suggesting that each year, one in every five persons who kills him/her self  (or 6,400 people) is a veteran, many note that there are more veterans who die by suicide each year than military members of service who die by combat overseas. 

In response to this grave concern, VA officials approached leaders at the Substance Abuse and Mental Health Services Administration and its federally-funded National Suicide Prevention Lifeline program (800-273-TALK) in early 2007, to discuss a partnership towards supporting the nation’s first 24-7 suicide prevention hotline for veterans of U.S. military service.  At the outset of our discussions, it became clear that the VA was approaching this initiative thoughtfully and creatively.  Rather than creating their own independent hotline service, they decided that building off an existing national suicide prevention hotline infrastructure had a number of elegant advantages.  Among those advantages are the following:

1) Veterans were already calling the Lifeline for help, and the VA’s marketing efforts for their service and the Lifeline’s national promotions could effectively work off each other to reach more veterans at risk;

2) The collective expertise of the Lifeline’s national network of over 140 local call centers could support the sharing of best practices among VA hotline workers;

3) Veterans who call the Lifeline number could have a choice to either get help through the VA’s special service or choose to be assisted by a local Lifeline network center;

4) Using the Lifeline number would assure that there would be one national suicide prevention hotline number for all Americans.

Consequently, the Lifeline has remained the number for all American residents in suicidal crisis, but now features a special service option for veteran callers.  When callers dial 800-273-TALK (8255), they hear an automated greeting, which prompts callers who are veterans (or persons calling for them) to “press one” if they would like the VA’s special service for veterans.  Callers who pressed “one” would then be routed to a national VA call center in New York, staffed by VA mental health professionals, some of whom are also veterans, all trained in suicide prevention approaches.  Lifeline callers not pressing “one” would otherwise be routed like any other caller to the nearest network crisis center. All veteran callers in crisis would be helped, and they would all have the choice as to whether they wished to be served by the VA or not.

SAMHSA and the VA signed an interagency agreement, and the VA contracted directly with the Lifeline’s administrator, Link2Health Solutions, Inc.  The nation’s first national suicide prevention service for veterans became a permanent component of the National Suicide Prevention Lifeline, and was launched in July 2007.

In a December 2007 Congressional Hearing, the IAVA’s Director of Government Affairs, Todd Bower, noted the positive changes afoot at the VA in response to the grave concern about suicidal veterans. “Recently, the VA had made great strides to improve communications lines by creating a nation-wide Suicide Prevention hotline”, Bower testified. “This hotline is available to veterans and their families 24 hours a day, seven days a week. This new program has had amazing results”, Bower further noted, citing several success stories reported by the VA.  Bower went on to say that the service needed to be more widely promoted so it could help even more veterans.

In more than two years since these Congressional Hearings, the service has become more widely known and has expanded.  In less than three years, more than 250,000 callers have now “pressed one” for the special veterans service on the Lifeline. However, the VA hotline service provides a lot more than confidential telephone support for emotionally distressed vet callers and their family members.  Because the VA is a “closed” system of care for veterans only, workers on the VA hotline can provide a number of special services that cannot be found through accessing the typical, non-VA crisis call center.

One remarkable service that the VA provides for its at risk callers is linkages to a “suicide prevention coordinator” (SPC).  The SPC initiative, which was in part  developed to complement the hotline service, consists of stationing VA caseworkers trained in suicide prevention at every VA Hospital in the country.  At risk veterans calling the hotline are followed up by the SPC, whose job is to ensure that the vet gets all the appropriate care that he/she needs to remain safe and gets his/her life back on track. 

The VA has engineered the widespread delivery of  high quality suicide prevention trainings and tools to all of its SPCs and hotline workers, to an unprecedented degree.  And, in 2009, the VA, again in partnership with the Lifeline, launched the VA’s first national online chat support service for veterans on the Lifeline web site (https://www.suicidepreventionlifeline.org/Veterans/Default.aspx ).  This confidential online service is not only the first established by the VA, but also the first 24-7 crisis chat service in the United States.  There is also no precedent for the SPC initiative in the country, where at risk persons are immediately followed up by a trained caseworker to assure his/her ongoing care.  The VA now has a hotline and chat service for homeless veterans, as well. 

This is not the VA that I used to hear about in my earlier years as a mental health care worker. 

In that Congressional Hearing back in 2007, the IAVA’s Todd Bowers stated that, “On the battlefield, casualties are often unavoidable. What is avoidable is suicide. If we take the proper steps to combat suicide among the veterans community, we can and will win this battle.” 

The VA has been fighting the good fight against suicide prevention.  Our only hope is that emotionally distressed, suicidal veterans will not let past perceptions of VA service deter them from accessing this vital, 24-7 confidential service today, if they need it. Call 800-273-TALK, press “1” if you’re a veteran, or  access the chat service and other information at www.suicidepreventionlifeline.org/Veterans/ .