September 17, 2021 • 39 mins
Dr. Ben Suitt joins Secretary Shulkin and Lou to talk about his recent study regarding the shockingly high numbers of veteran suicides. He explains that the recent drop in suicides reported by the VA, might just be a numbers game that doesn't reflect reality.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Ben Suitt (00:02):
We're talking about over 30,000 post 911 era
veterans and active componentservicemembers dying by suicide
compared to the, at the time Ireport 7057 servicemembers who
died in military operations it'sit was just absolutely
staggering, realizing thepandemic is going to have an
effect. I think the thing that'sreally going to have an effect
is this. Pulling out ofAfghanistan, the the call volume
(00:24):
to the National Veterans suicidehotline has been increasing. And
that does seem to be anindicator that we are wrestling
with more suicidal ideation atthe moment, and it will be
really important to see this2021 numbers when ever they do
catch up.
Announcer (00:47):
Welcome to the policy bets podcast engaging with
leaders, scholars and strongvoices to fill a void in support
of policy development forAmerica's veterans. With your
hosts, former Secretary ofVeterans Affairs, Dr. David
Shelton, and former executivedirector of the American Legion
Louis Celli. Today's guest isDr. Ben suit, a contributor to
(01:08):
the Brown University WatsonInstitute, cost of war project.
Louis Celli (01:15):
Mr. Secretary, so is September is National Suicide
Awareness Month, I think it'simportant that we that we wrap
up the month talking about thisextremely important issue.
Dr. David Shulkin (01:26):
Blue, it's hard for me to think about
suicide prevention being amonth, because this is a year
long issue. Of course, as youknow, this was the top issue for
me when I was at VA andcontinues to be a top priority
for VA and the administration
Louis Celli (01:45):
now and rightfully so. And as a matter of fact, I
don't know if it was time tothis way, but they just dropped
their most recent report just acouple of days ago.
Dr. David Shulkin (01:54):
Yeah, you know, these reports have taken
on a lot of importance. I thinkthat the first suicide reports.
For VA, it covered a periodbetween 2001 to 2014. It was
released when I was under asecretary. And it was really
quite disturbing when we saw theimpact of this data. And each
(02:19):
year, a report has come out tobe able to monitor the progress
that we've been making.
Louis Celli (02:24):
What really surprised me was there was no
national mechanism by which totrack this, the VA actually had
to go to each state and pull allof the death records and count
them manually, which is issomewhat archaic, you would
think that there would be somekind of national reporting
system?
Dr. David Shulkin (02:43):
Well, I think even in this most recent report,
you see that the data lags twoyears behind their reporting on
suicides from 2019. And theworld has changed dramatically
since 2019, with the pandemicand the withdrawal from
Afghanistan. And there has to bea better way of getting more
accurate and faster data so wecan actually follow the progress
(03:07):
and the issues that arehappening at the time. So this
is a report that needs to sortof enter the 21st century and
get real time data collection.
Louis Celli (03:18):
I'm really glad you said more accurate data, because
I've always wondered, andtheorized that the data that
they collect, that has beendocumented in death records
doesn't account for a great manysuicides. There are religious
reasons why people don't wantsuicide listed on a on a death
(03:39):
certificate. There are insurancereasons that people don't want
it listed. There are pridereasons or familial reasons.
There's the whole single caraccident, you know, death by
cop, there's just all of theseother factors that play into
someone seeking a way to endtheir own life, that doesn't
always get recorded in suicide.
And I think we have to find away to capture that information.
(04:01):
But there's
Dr. David Shulkin (04:03):
no doubt that these data are under recording
the true incidence. So what'shappening for all the reasons
that you said. But I can tellyou, the people at VA who put
together these reports, reallytry hard to make these reports
accurate, but they have to relyupon the way that these are
reported at the local levelsthat rolls up to the CDC
(04:27):
mortality index. And it's justreally hard to make sure that
these are accurate. One of thethings that makes it even more
challenging for people tounderstand it seems like the
definitions of how they reporton suicides are changing gear
ear so it's really hard tofollow whether we are making
progress or or gone backwards.
Well, it's
Louis Celli (04:51):
not just the definitions that are changing
from year to year. Each of thesereports have changed the
structure, the way they reportthe way they count the way They,
the way they present thereports, it makes it extremely
difficult to go back to eachreport and figure out whether
progress is being made orwhether we're counting the same
(05:11):
numbers, the same groups of ofage groups, time periods and
service. It actually looks likein this most recent report that
the numbers have gotten betterthat, that we've gone from 18
suicides a day for veterans downto 17. But you have to pull that
out of the report. It's veryhard to read these.
Dr. David Shulkin (05:32):
Yeah, it really is. And, you know, I've
gone through these reports totry to see whether you can make
accurate comparisons. Of course,many people still use the number
22 veterans a day. I think whenyou take a look at the data, and
you try to compare apples toapples, we probably still are
(05:55):
and always have been around 20veterans a day that are taking
their own life. I do think thatthis recent report that was
released, does have some reasonto be optimistic. It looks like
there may be a trend, thatnumber may be decreasing. But I
certainly think it would be waytoo premature to declare mission
(06:20):
accomplished or that we're, wefigured out exactly the right
way to be able to address thissituation.
Louis Celli (06:28):
Mr. Secretary, that is such a great point. So what
do you attribute the lowernumbers to? Is the government
getting it better? Is societygetting it better? Like? How do
we get better?
Dr. David Shulkin (06:41):
I don't think that you can simply give an
answer to that. I think that thefocus of the agency, the focus
of so many community groups, thepublic attention to veteran
suicide, clearly should be partof why things may be getting
better. And the fact that peoplenow are more willing to reach
(07:06):
out when they have problems,that the stigma of mental health
issues and asking for help isfinally beginning to be taken
away so that people aren'tembarrassed about saying that
they have an issue that theyneed help with. But, you know, I
want to just return lewd to thethings that I think we do know
(07:27):
work. When it comes to veteransuicide in the prevention of
veteran suicide. The realsuperpower here is peer support.
And I think that it's notrecognized enough. When veterans
are experiencing issues, theywant to talk to other veterans
who know what they've gonethrough. And the power of peer
(07:50):
support, I think is the singlebiggest weapon that we have. The
second issue is is that the areawhere the biggest concern still
exists is that one year periodafter transitioning out of the
military back into the civilianpopulation. And while we've been
(08:10):
talking about reverse bootcamps, for a while, we just
haven't seen it done. And wehaven't seen it done well. So I
think that that's something thatneeds to be done. The third
areas is that when you look atthe way that many veterans take
their lives, it isoverwhelmingly with firearms,
(08:31):
and that's much higher than thecivilian population. So we've
got to begin to address death byfirearms in a way that has been
very, very complicated to takeon. And finally, I really want
to make sure that peopleunderstand people don't take
their lives just because theywake up one day and decide that
(08:56):
that's the only alternative.
These have to do with theunderlying conditions that
people are experiencing.
Depression, PTSD, chronic pain,substance abuse. And so looking
at the effectiveness of ourbehavioral healthcare system,
and looking at the ways that wecan begin to do early
(09:17):
identification and effectivetreatments, I think is
ultimately going to be the longterm solution here.
Louis Celli (09:23):
You've touched on so many really great points
here. And one of the things thatthat you talked about was a
sense of community and peersupport. I think it's important
to look at things like moralinjury, our guest today, Dr. Ben
suit is going to talk a littlebit about moral injury. And
what's interesting in hisreport, I don't think he
(09:44):
mentions it when we talk to himbut in his report, he even
highlights the DSM five, theDiagnostic Statistical Manual,
the Bible for mental healthdoesn't even have a section on
moral injury yet, and I thinkit's important that we talk
about that The other thing thatyou talked about is, you know
what we're getting right. And Iabsolutely have to believe in my
(10:07):
core, that the Veterans CrisisLine is making a difference. I
don't know if you can attribute,you know, the the drop in
suicide rates that we're seeingnow that the trend that that
could be going down. I don'tknow if we can attribute that to
the Veterans Crisis Line. Butthe amount of calls that I know
that they get, the work thatthey do, and some of the stories
(10:30):
that we've heard coming out ofthat has got to be making a
difference somewhere. And, youknow, finally, the, you know,
that sense of belonging, if aveteran reintegrates, like you
talked about a reverse bootcamp, when veterans reintegrate
back into into the into thesociety, I think that we as a
community, I know that veteransrecognize this, but the society
(10:53):
has to remember that theirentire life has changed. And
it's changed in a way that it'snot only their career, but it's
their support network. It's theit's the culture that they used
to operate in, whether it was acombat culture, or just being on
base. They've been, essentiallyair dropped back into society.
(11:15):
And it takes it takes a periodof readjustment. And if that
readjustment doesn't go, well,it's really just going to
contribute to the veteran notbeing as as successful, which
can also contribute to divorcerates, unemployment. And then
ultimately, in some cases, verytragically, veteran suicide.
Dr. David Shulkin (11:33):
I think these are such important points low I
think, you know, your pointabout the veteran crisis line, I
can't imagine a harder morestressful job than being a
person who answers that, thatblind in on the phone all day
long. And I've spent time withthe Veterans Crisis Line
responders, these are amazingpeople. And where else can you
(11:55):
find somebody to talk to atthree o'clock in the morning,
so. So I have no doubt that theyare part of the solution here.
The other thing that youmentioned was the interaction
with the community. As we know,the vast majority of veterans
that take their own lives aren'tgetting care in the VA system,
(12:16):
they're out in the community. Sothey're interacting with, you
know, their neighbors, withtheir churches and the Veteran
Service groups, and you know,people at work. And so getting
people to recognize whensomebody needs help, and being
there to reach out to them to bethat listening partner, I think
(12:36):
is so important. And that's whythese educational efforts, and
even things like our podcaststhat's talking about it is
educating people as to why thisis so important.
Louis Celli (12:46):
I couldn't agree more. So let's, let's get Ben in
here. And let's let's go throughsome of these issues that he
talks about, you know, like themoral injury in the sense of
belonging. And when veteranscome back, if if they don't feel
like they're a valued member ofthe society. One of the top
things that we've heard, and I'mnot even sure if it's outlined
(13:07):
in this paper or not, but I'veheard it time and time, again,
is that when veterans haveincomplete suicides, and we're
able to interview them, whatthey often say, or what they
leave in notes are things like,I didn't want to be a burden.
And they feel like they're beinga burden, they don't feel
useful. And that is somethingthat we can all address. That's
(13:27):
something that we can address
Dr. David Shulkin (13:29):
today.
Couldn't agree more. So whydon't we get started? Let's do
that.
Louis Celli (13:41):
Ben, thank you for joining us today on the policy.
That's podcast.
Dr. Ben Suitt (13:44):
Thank you so much for having me, Lou. I really
appreciate you inviting me on.
Dr. David Shulkin (13:47):
Ben. Good morning. Thanks for being on
with us. Can you start by justtelling us why you decided to do
research about veterans suicide?
Dr. Ben Suitt (13:56):
Yes. So I was working on my dissertation work
at Boston University and theReligious Studies Department.
And I was looking at the role offaith in the lives of post 911
veterans. And so oftentimes,faith would be something that
was very positive for them. Butit could also be something that
could end up being damaging. Soif you imagine being told your
(14:17):
entire life, that killing iswrong, and then you find
yourself in a position where youare killing others, this could
be something that could upendsort of your view of religion in
the world, and your relationshipwith God. And so in looking at
that, I spoke with over 50veterans and military chaplains
about their experiences. Andsomething that became very clear
(14:38):
was that the majority of themhad stories of trauma, and those
that didn't, certainly knewothers who had one of my mentors
Professor Nita Crawford, who wasworking on tallying up the
actual cost, like financial costof the wear and tear. She knew
that I was working on a conceptcalled moral injury. And
(15:00):
relating that to the stories offaith and trauma that I heard.
And so she asked me to look intothe mental health costs of the
post 911 wars. And what becameclear was the way to talk about
that was to talk about theincreasing rates of suicide,
particularly when I got my handson the data.
Louis Celli (15:16):
Yeah, one of the things that I really appreciated
about the paper is that you'vedone a really good job in
collecting information just froma variety of sources. So what
did you find to be the mostdifficult data to procure, and
what data surprised you themost,
Dr. Ben Suitt (15:32):
and the most difficult data to procure was
the Department of Defense dataonly, because if you look at
their annual reports, they willso they will show trend lines,
but they don't necessarily showall of the data over the years.
And so I did have to put in arequest with the department
defense suicide event report.
And eventually, the defensehealth agency got back to me
with those exact figures. One ofthe difficulties there as well
(15:56):
was that they've only reallyconsistently begun counting
suicides since 2008. And they'veonly had a consistent scale and
way of adjusting those ratessince 2011. So the data there is
difficult to put together,particularly because before
(16:16):
2008, you had this sort of broadcategory called self inflicted,
but self inflicted isn'tnecessarily suicide, that could
be a car wreck, or a weaponmisfire, drug overdose. And so
there's a bit of piecing thepast together to be able to get
the right denominator and get anaccurate number for suicide. But
the most surprising dataoverall, was really just the
(16:40):
putting the sheer volumetogether when I was even looking
at the veteran data, the VAdoesn't separate their data by
era of war. Which makes sense, alot of Gulf War Veterans also
fight in post 911 wars. But itdoes make it tricky, trying to
piece together those numbers.
(17:02):
And so going by agedemographics, and then also
comparing that with thepercentage to total that we know
of veterans who fought in post911 wars. When those numbers
came back and realizing thatwe're talking about over 30,000
post 911 era veterans and activecomponent servicemembers dying
(17:22):
by suicide compared to the thetermite report 7057
servicemembers who died inmilitary operations, it's it was
just absolutely staggering. Andjust to update their the the
current number as of September6, for those that have died in
military operations is 7074.
Dr. David Shulkin (17:41):
For a while now the VA Department of
Defense, the President, Congresshave really prioritized veteran
suicide and have put theresources into programs have
worked hard to make thissomething that they're really
working on. So you say in yourpaper that we need to do more,
(18:02):
what do you think the VA theDepartment of Defense the
Congress needs to be doing inorder to do more?
Dr. Ben Suitt (18:09):
That's a great question. The I think, in a
broad term looking at this, itwould be that we need to be more
proactive rather thanreactionary. So the way the
system is set up right now isthat we pour billions of dollars
into the VA to help veteranswith suicide. But the amount of
spending that we put into theactual armed forces for suicide
(18:32):
prevention is just a drop in thebucket. It's nowhere in the
realm of what we spend forsuicide prevention. With the VA.
It comes down to this sort offrustrating aspect that the
Department of Defense likes touse this logline I talked about
in my report, but that becausethe suicide rates among active
component service members areabout the same as those in the
(18:55):
civilian population, thatthere's not a problem, except we
know historically that the ratesof active component service
members are lower than that ofthe civilian population and
tended to go down in wartime,after World War One, except for
Vietnam, and now post 911 wars.
So that rate has come to meetthe civilian population. And
looking at the most recent data,it looks as though it has
(19:18):
surpassed the civilian rate.
They haven't released numberssince 2018. They do have a
problem on the front end thatthey do need to be focusing on
the Department of Defense in thearmed forces. They're very good
at, you know, maintaining theirweapons, taking physical fitness
very seriously. But they're notso great at looking at mental
health as a force multiplier,and realizing that just as they
(19:41):
service their weapon andmaintain their physical fitness,
they need to be taken care oftheir mental health as well.
Louis Celli (19:47):
Your paper is is pretty relevant. You dropped it
last month. And then right afterthat, as you mentioned, the VA
has dropped some recent data tocover 2018 so My question is it
looks like from VA is morerecent data, that the the number
(20:07):
of daily veteran suicides hasactually dropped from from 18 a
day to 17 a day. But accordingto your research, they're not
really counting all of theveteran categories. Can you
explain that
Dr. Ben Suitt (20:18):
the data used to say that 22 veterans died per
day, they've been adjusted theway that they count veterans.
And so the 22 a day was countingjust a brighter category. So it
could be national gardenreserves, who were never
federally activated a broaderpart of the military, that just,
they decided didn't quite countin terms of those veteran
(20:39):
numbers. So when they made thatadjustment, it did bring it down
to 18. And it does look likeit's gone down to 17. So when
you try to look at those broadernumbers, for just those in the
reserves and National Guard, whomaybe were not federally
activated, they, the Departmentof Defense would point you to
sort of civilian records,because they civilian records
(21:01):
would show whether they died bysuicide, but that wouldn't be
captured in the Department ofDefense records.
Dr. David Shulkin (21:06):
Well, why do you think that they made a
switch in the way that theycount, because when they were
counting it as 22 veterans, theyincluded the National Guard, and
then they changed it, and insome cases have been claiming
that this is progress. But whatyou're saying is this is really
(21:27):
just looking at two differentgroups of of people instead of
keeping it with this similardefinition. So what's your
explanation why they changed theway that they count us?
Dr. Ben Suitt (21:40):
One of the reasons was that, before they
made that switch, there mighthave been potential overlap
between the Department ofDefense reports and the VA
reports. I think they're alsoworking on trying to have a more
consistent denominator with whothey're counting. And in
addition to that, they areprobably not counting them,
because they are trying to keepthe focus on what problems might
(22:02):
be unique for veterans, theymight put those suicidal
problems up to societal issuesrather than military issues. I
don't know that that's correct.
I think that being involved inthe military organization is
going to affect your life insome way. But I think that
that's probably their logic.
Louis Celli (22:21):
Tell us some stories about the veterans that
you've interviewed some of thesome of the folks that you spoke
with, what our listeners reallywant to hear is they want to
hear, you know, kind of thatthat personal interaction, and
the numbers are important. Theywant to, but they want to hear
really about the human stories.
And I'm curious, what are thenumbers today, right? So if
(22:42):
they're not counting everything,and your research has been able
to kind of tease out thatthey've missed, really some
categories, or you know, justnot even looking at it. If we
were to add all the categoriestogether, what would those
numbers look like today,
Dr. Ben Suitt (22:59):
adding those numbers up together does look
like about 30,177 is my veryconservative estimate of how
many may have died. The reason Iwent with a conservative
estimate is just making surethat I'm not overstating because
that wouldn't end up beinguseful. But to your point about
stories of that I've heard Imean, I, I sort of opened my
(23:20):
report with Ford observer, hewas in Cedar City at a sort of
very violent time and chosenfive and afford observer. They
like to call themselves sistersor Pfister's. But they do have a
very dangerous job having to gosort of deep into enemy
(23:41):
territory to make those callsabout where to aim artillery.
The officer that I was speakingwith, he realized that the
youngest in his sort of unitthat he was in charge of caring
for died, and he felt personallyvery guilty for it. He said that
he remembered praying to God,and asking for God to protect
(24:04):
his men. And when that young mandied, he said it just absolutely
destroyed his his worldview andhis faith. But he said the real
work actually came when he camehome. He finally had a sort of
the ability to reflect on hisexperiences, and for the first
time, realize what hisexperiences did to him and his
(24:28):
in his life, and he developedsuicidal ideation and post
traumatic stress had moralinjury. More than that, when he
started speaking with otherpeople in his unit, he realized
that they were having adifficult time too. And at the
time of speaking with me, herevealed that more people in his
unit had died by suicide thanever died in combat, despite
being in Seder city in such adangerous time. And when I
(24:51):
looked at his story, and otherstories of people I spoke with
it became clear that many ofthem had similar stories.
Realizing that people in theirunit had died that they knew
people had died by suicide. evenlooking at Iraq and Afghanistan
Veterans of America data, itseems that well over 60% of
(25:12):
veterans who fight and post 911wars, know someone who
successfully attempted or hasattempted suicide, if if they
didn't attempt it themselves.
Dr. David Shulkin (25:23):
One of the challenges of the data that you
talk about, and the data thatyou had to get from VA and the
Department of Defense is that itlags by a couple of years, I
think the report that just cameout is 2019 data. So it's two
(25:43):
years old. And of course, a lothas changed in these past two
years, we've had a pandemic,we've now disengaged from
Afghanistan, which has had a bigimpact on many of our veterans
who have served in the recentconflicts. So what do you think,
(26:03):
has happened to the suiciderate? in these last couple
years? What do you think we'regoing to see two years from now?
And what do you think the impactof both the pandemic and the
withdrawal from Afghanistan isgoing to have on the suicide
rates?
Dr. Ben Suitt (26:19):
So the numbers that came out, just this past
week from the VA, wereheartening, because it did show
that the rate even among the 18,to 34 demographic, which tends
to that is certainly thedemographic that has the most
post 911 veterans, that thoserates have gone down the lowest
numbers that it's been since2015. So that is great. But to
(26:43):
your question, it's hard to knowhow the pandemic is going to
affect that when I spoke withMatt Miller, who's the national
director of suicide preventionat the VA, he said, the raw data
coming in looks like it mightcontinue to go in a downward
trend, I'll be very interestedto see if that's actually true.
But if you look at just thetotal number of people who die
by suicide, it's going to looklike the 55 to 74 demographic is
(27:08):
hurting the most. But when we'relooking at this data, it's
really important to think aboutthe rate per 100, or 100,000,
not just the lump sum totals.
And so the demographic that'shurting the most is that 18 to
34 demographic, realizing thepandemic is going to have an
effect, I think the thing that'sreally going to have an effect
is this pulling out ofAfghanistan, one of the things
(27:29):
that's been going around in thenews, and the Daily Beast was
the first to sort of break thestory, but the the call volume
to the national veteran suicidehotline has been increasing
since the pulling out ofAfghanistan. And that does seem
to be an indicator that we arewrestling with more suicidal
(27:50):
ideation at the moment. And itwill be really important to see
those 2021 numbers when everthey do catch up.
Louis Celli (28:00):
You know, you've mentioned moral injury Now a
couple of times and and I wantto drill down on that something
that I really found to be veryhelpful in your writing in your
paper, was the fact that youactually list a variety of
different stressors thatcontribute to veteran suicide,
which is something that thatother papers really don't
(28:24):
highlight that as much and Ithink that that's important. Can
you talk a little bit about that
Dr. Ben Suitt (28:28):
about moral injury specifically,
Louis Celli (28:30):
not just about moral injury but you know,
there's a there's a list moralinjury, loss of purpose divorce,
a nation that doesn't get it, Ithink that's extremely
important. Veterans a wonderingif their sacrifice was worth it.
One statistic that did surpriseme was the number of adults that
you that were polled thatactually thought that the war
was over years ago. I mean, thatthat really surprised me. So can
(28:53):
you talk a little bit aboutthat?
Dr. Ben Suitt (28:55):
Absolutely. So when I looked at the the
possible causes for increasingrates and suicide, I realized
that there were we couldcategorize them into two
different parts. So on the onehand, you have things that would
be novel to the post 911 wars,and on the other hand, you would
have things that might be trueof all wars, and what those
things that would be unique tothe post 911 Wars post have
(29:16):
words were characterized withjust a tremendous increase in
the number of improvisedexplosive devices on the part of
enemy forces. So this would justitself create an enhanced state
of fear or stress burden onservicemembers that that alone
could increase suicidalideation. But for those that
experienced improvised explosivedevice explosions, this led to a
(29:38):
tremendous increase in thenumber of traumatic brain
injuries. But what we also hadwere incredible medical advances
that meant that if a person hada traumatic brain injury, they
were also likely to be able tobe redeployed, because we're
able to help them. The issue isthat IEDs were used to such a
degree that traumatic braininjuries became It was called
(29:58):
the signature injury of The waron terror. And so servicemembers
would come back with a traumaticbrain injury and then be
redeployed. And this wouldhappen over and over to the
point that the sort of theaverage was around three. But
the higher estimates were 15traumatic brain injuries and
still being redeployed. Andanecdotally, with veterans I
(30:20):
spoke with, they would say, Oh,I knew a guy who had 20. So
fortunately, soldiers andservice members are surviving.
Unfortunately, having increasedtraumatic brain injuries that
compound on one another, thatseverely increases the rate of
suicidal ideation among thatgroup, in addition, that if
you're surviving injuries thatmight otherwise take you out of
(30:41):
the fight, but you're able toredeploy, you might develop
chronic pain. Also, justexperiencing trauma, you're
going to have your body'snatural response to trauma,
which is what we call PostTraumatic Stress Disorder, but
it's just that deep in theamygdala, you're able to
continue to have this fight orflight response that just won't
shut off. And so those threetogether we call poly trauma or
(31:03):
the clinical triad, and that isvery closely tied to increasing
rates of suicidal ideation. Inaddition to that, you have what
is similar to what happened inVietnam, but it is unique to
post 911 wars. It's just thestereotypes and the societal
burden of being a veteran. Andso in Vietnam, it would be that
(31:27):
they would call returningveterans, baby killers or awful
things like that the point thatveterans of Vietnam felt like
they were never welcomed homethat they were outside of
society, what it was like forpost veterans is coming home,
that they would be treated asheroes, even those that didn't
feel as though they had donethings that were heroic. But at
(31:48):
the same time when they'retreated like they were
necessarily broken people thatcan make them feel as though
they're outsiders to society.
But couple that with the thepoint, you mentioned that 42% of
the voting public in 2018,didn't realize we were still
fighting the war on terror, thatcan also cause a bit of an issue
when your identity is wrapped upinto the fact that you fought in
(32:09):
the war, that you gave up a partof your life, and you come back
to a public that is so deeplyapathetic to what's going on,
that they don't even realize thesacrifices you've made. And I
think that that does end uptying to what's going on with
pulling out of Afghanistan. It'sjust this idea that, you know,
(32:29):
if it's a big part of youridentity, that you were doing
good work, or that what you didhad a purpose. And suddenly,
we're leaving the nation,basically, where we found it
either worse off or about thesame. That that can sort of
disrupt this narrative that wewe all carry that I'm a good
person, I'm doing good work. Ifyou suddenly feel as though all
(32:52):
of your life's work or thesacrifice, you made work for
nothing that can enhancesuicidal ideation.
Dr. David Shulkin (32:59):
I want to go back to clarifies some of the
discussion that that you weretalking to us about before about
whether being in combat actuallybeing deployed into an area with
conflict? is a risk factor forsuicide? Or is it actually a
(33:22):
protective factor? And are weseeing more suicides on the
people that aren't deployed? Canyou just clarify that?
Dr. Ben Suitt (33:30):
Yes, there's some nuance there. So when we look at
the rates among those in combatroles versus those in support
roles, depending on the year, itcan look like the rates among
support roles are higher thanthose in combat roles. And so
something that I've seen in areport before was that being in
combat might be a protectivefactor that is, would only be
(33:53):
true to a very specific point.
So we know that witnessingatrocities or perpetrating
atrocities yourself, do increasesuicidal ideation, and suicide
risks. So it's sort of like thetype of combat would make a
difference. So if you'veexperienced atrocities, or if
you have perpetrated violenceyourself, those suicide rates do
go up. But it is an importantpoint to bring up that you don't
(34:16):
need to be in combat to havehigh suicide rates. So those in
support roles do have highsuicide rates. That can be for a
number of reasons. One can besecondary trauma. So being in a,
an organization that does a lotof good, but also does a lot of
violence can increase your riskfor suicide. But one important
issue to bring up is alsomilitary sexual trauma, which is
(34:38):
a unique form of sexual traumabecause the victim often has to
continue working with theirattacker and this affects both
women and men. But especiallywomen that is certainly linked
to the development of posttraumatic stress, but also it's
a an indicator of risk forsuicide as well. Just milk
(34:58):
sexual trauma,
Louis Celli (35:01):
in addition to the data in your paper that talks
about the higher, higheraccounts of suicide among
veterans who were not deployed,you also talk about the highest
amount of suicides among Guardmembers. Can you talk a little
bit about that?
Dr. Ben Suitt (35:18):
Yes. So while my, my report doesn't focus as much
on the National Guard, it doesappear depending on the year
that the National Guard rates dotend to be among the highest, if
not the highest, often sort ofneck and neck with the army,
those rates do seem to be up. Ithink one of the things in post
911 Wars specifically is thatthe National Guard was deployed
(35:41):
under the purview of the army,that the National Guard would be
put into positions that maybewhen they sign up for National
Guard, they weren't really theydidn't suspect that they would
be called upon to have boots onthe ground and be fighting. In
that way. One of the NationalGuard men that I spoke with his
job was just he was going to bejust doing sort of operational
(36:03):
management dealing with supplylines. And when he was deployed
to the Middle East, he realizedthat they were going to be
changing his role. So where hethought he was going to be doing
operational management,suddenly, they were putting him
on convoys, and putting theminto war zones, and he was going
to have to fire on the enemy.
He's specifically said that henever signed up for that,
(36:24):
obviously, you know, going tothe military, you're certainly
trained to use your weapon. Buthe wanted to seek out support
roles, he never wanted to haveto kill someone. And now
suddenly, he found himself inthat position, it did end up
sort of wrecking his hisworldview. And it's just such a
tragic story, because being putinto a position where when you
(36:45):
signed up, and you're makingthat commitment, but you did
specifically sign up forNational Guard, knowing what
that would look like, theNational Guard tends to be one
foot in the military and onefoot in the civilian world,
having that significant rolechange. I just can't imagine
what that would do.
Louis Celli (37:04):
We could cover your paper for the next hour and a
half. I mean, it's very rich anddata. As a matter of fact, we're
going to go ahead and post it onour website. Before we go, I
want to ask you, what can we asa community, VA, the government,
what can we be doing better?
Dr. Ben Suitt (37:21):
In terms of civilians, I think that the what
we can do better is to inviteveterans into our communities,
it is shown that even justreaching out lowers suicide
rates. So showing care. ThatRasmussen study that showed 42%
of the voting public didn'trealize we are at war is so
(37:42):
upsetting that it's just absurd.
So showing care, being involvedin veteran lives, coming back to
the civilian world is difficult,you know, your identity changes,
when you enter the military, youbecome a warrior. And having to
come back to the civilian world,you know, the change back to
being a civilian doesn't happenovernight. And it would
certainly help for civilians tobe involved in that. In terms of
(38:03):
the VA, I think they need to tryto begin taking more holistic
approaches, they tend to focuson one specific piece. But as my
report shows, taking care of onepiece is not going to solve the
problem, we have to look at itfrom so many different angles.
And in terms of the Departmentof Defense, they need to take
(38:27):
suicide prevention moreseriously. And think about ways
to reframe it so that activecomponent service members take
help seeking attitudes moreseriously.
Louis Celli (38:39):
Then that really covers the question that I was
going to ask you last before weleft and that is to summarize,
you know, your your, yourresearch in your report in about
two sentences, but you just dida perfect job. Listen, I really
want to thank you for joining ustoday and absolutely time to to
speak with us.
Dr. Ben Suitt (38:57):
Thank you so much for having me. I really
appreciate it.
Dr. David Shulkin (38:59):
Thank you.
Louis Celli (39:03):
Well, that's gonna be it for today. Hey, join us
next week we have a very specialguest the honorable Randy
Reeves, who's the former VAUndersecretary for Memorial
affairs. He was also the statedirector for veterans affairs in
Mississippi. And he's going totalk to us about state veterans
homes. When veterans die instate Veterans Home who's
responsible? Find out next week.
Announcer (39:27):
Thanks for listening to the policy. That's podcasts.
For more information aboutprojects and other podcasts, go
to policy. That's dot org.
We're talking about over 30,000 post 911 era
veterans and active componentservicemembers dying by suicide
compared to the, at the time Ireport 7057 servicemembers who
died in military operations it'sit was just absolutely
staggering, realizing thepandemic is going to have an
effect. I think the thing that'sreally going to have an effect
is this. Pulling out ofAfghanistan, the the call volume
(00:24):
to the National Veterans suicidehotline has been increasing. And
that does seem to be anindicator that we are wrestling
with more suicidal ideation atthe moment, and it will be
really important to see this2021 numbers when ever they do
catch up.
Announcer (00:47):
Welcome to the policy bets podcast engaging with
leaders, scholars and strongvoices to fill a void in support
of policy development forAmerica's veterans. With your
hosts, former Secretary ofVeterans Affairs, Dr. David
Shelton, and former executivedirector of the American Legion
Louis Celli. Today's guest isDr. Ben suit, a contributor to
(01:08):
the Brown University WatsonInstitute, cost of war project.
Louis Celli (01:15):
Mr. Secretary, so is September is National Suicide
Awareness Month, I think it'simportant that we that we wrap
up the month talking about thisextremely important issue.
Dr. David Shulkin (01:26):
Blue, it's hard for me to think about
suicide prevention being amonth, because this is a year
long issue. Of course, as youknow, this was the top issue for
me when I was at VA andcontinues to be a top priority
for VA and the administration
Louis Celli (01:45):
now and rightfully so. And as a matter of fact, I
don't know if it was time tothis way, but they just dropped
their most recent report just acouple of days ago.
Dr. David Shulkin (01:54):
Yeah, you know, these reports have taken
on a lot of importance. I thinkthat the first suicide reports.
For VA, it covered a periodbetween 2001 to 2014. It was
released when I was under asecretary. And it was really
quite disturbing when we saw theimpact of this data. And each
(02:19):
year, a report has come out tobe able to monitor the progress
that we've been making.
Louis Celli (02:24):
What really surprised me was there was no
national mechanism by which totrack this, the VA actually had
to go to each state and pull allof the death records and count
them manually, which is issomewhat archaic, you would
think that there would be somekind of national reporting
system?
Dr. David Shulkin (02:43):
Well, I think even in this most recent report,
you see that the data lags twoyears behind their reporting on
suicides from 2019. And theworld has changed dramatically
since 2019, with the pandemicand the withdrawal from
Afghanistan. And there has to bea better way of getting more
accurate and faster data so wecan actually follow the progress
(03:07):
and the issues that arehappening at the time. So this
is a report that needs to sortof enter the 21st century and
get real time data collection.
Louis Celli (03:18):
I'm really glad you said more accurate data, because
I've always wondered, andtheorized that the data that
they collect, that has beendocumented in death records
doesn't account for a great manysuicides. There are religious
reasons why people don't wantsuicide listed on a on a death
(03:39):
certificate. There are insurancereasons that people don't want
it listed. There are pridereasons or familial reasons.
There's the whole single caraccident, you know, death by
cop, there's just all of theseother factors that play into
someone seeking a way to endtheir own life, that doesn't
always get recorded in suicide.
And I think we have to find away to capture that information.
(04:01):
But there's
Dr. David Shulkin (04:03):
no doubt that these data are under recording
the true incidence. So what'shappening for all the reasons
that you said. But I can tellyou, the people at VA who put
together these reports, reallytry hard to make these reports
accurate, but they have to relyupon the way that these are
reported at the local levelsthat rolls up to the CDC
(04:27):
mortality index. And it's justreally hard to make sure that
these are accurate. One of thethings that makes it even more
challenging for people tounderstand it seems like the
definitions of how they reporton suicides are changing gear
ear so it's really hard tofollow whether we are making
progress or or gone backwards.
Well, it's
Louis Celli (04:51):
not just the definitions that are changing
from year to year. Each of thesereports have changed the
structure, the way they reportthe way they count the way They,
the way they present thereports, it makes it extremely
difficult to go back to eachreport and figure out whether
progress is being made orwhether we're counting the same
(05:11):
numbers, the same groups of ofage groups, time periods and
service. It actually looks likein this most recent report that
the numbers have gotten betterthat, that we've gone from 18
suicides a day for veterans downto 17. But you have to pull that
out of the report. It's veryhard to read these.
Dr. David Shulkin (05:32):
Yeah, it really is. And, you know, I've
gone through these reports totry to see whether you can make
accurate comparisons. Of course,many people still use the number
22 veterans a day. I think whenyou take a look at the data, and
you try to compare apples toapples, we probably still are
(05:55):
and always have been around 20veterans a day that are taking
their own life. I do think thatthis recent report that was
released, does have some reasonto be optimistic. It looks like
there may be a trend, thatnumber may be decreasing. But I
certainly think it would be waytoo premature to declare mission
(06:20):
accomplished or that we're, wefigured out exactly the right
way to be able to address thissituation.
Louis Celli (06:28):
Mr. Secretary, that is such a great point. So what
do you attribute the lowernumbers to? Is the government
getting it better? Is societygetting it better? Like? How do
we get better?
Dr. David Shulkin (06:41):
I don't think that you can simply give an
answer to that. I think that thefocus of the agency, the focus
of so many community groups, thepublic attention to veteran
suicide, clearly should be partof why things may be getting
better. And the fact that peoplenow are more willing to reach
(07:06):
out when they have problems,that the stigma of mental health
issues and asking for help isfinally beginning to be taken
away so that people aren'tembarrassed about saying that
they have an issue that theyneed help with. But, you know, I
want to just return lewd to thethings that I think we do know
(07:27):
work. When it comes to veteransuicide in the prevention of
veteran suicide. The realsuperpower here is peer support.
And I think that it's notrecognized enough. When veterans
are experiencing issues, theywant to talk to other veterans
who know what they've gonethrough. And the power of peer
(07:50):
support, I think is the singlebiggest weapon that we have. The
second issue is is that the areawhere the biggest concern still
exists is that one year periodafter transitioning out of the
military back into the civilianpopulation. And while we've been
(08:10):
talking about reverse bootcamps, for a while, we just
haven't seen it done. And wehaven't seen it done well. So I
think that that's something thatneeds to be done. The third
areas is that when you look atthe way that many veterans take
their lives, it isoverwhelmingly with firearms,
(08:31):
and that's much higher than thecivilian population. So we've
got to begin to address death byfirearms in a way that has been
very, very complicated to takeon. And finally, I really want
to make sure that peopleunderstand people don't take
their lives just because theywake up one day and decide that
(08:56):
that's the only alternative.
These have to do with theunderlying conditions that
people are experiencing.
Depression, PTSD, chronic pain,substance abuse. And so looking
at the effectiveness of ourbehavioral healthcare system,
and looking at the ways that wecan begin to do early
(09:17):
identification and effectivetreatments, I think is
ultimately going to be the longterm solution here.
Louis Celli (09:23):
You've touched on so many really great points
here. And one of the things thatthat you talked about was a
sense of community and peersupport. I think it's important
to look at things like moralinjury, our guest today, Dr. Ben
suit is going to talk a littlebit about moral injury. And
what's interesting in hisreport, I don't think he
(09:44):
mentions it when we talk to himbut in his report, he even
highlights the DSM five, theDiagnostic Statistical Manual,
the Bible for mental healthdoesn't even have a section on
moral injury yet, and I thinkit's important that we talk
about that The other thing thatyou talked about is, you know
what we're getting right. And Iabsolutely have to believe in my
(10:07):
core, that the Veterans CrisisLine is making a difference. I
don't know if you can attribute,you know, the the drop in
suicide rates that we're seeingnow that the trend that that
could be going down. I don'tknow if we can attribute that to
the Veterans Crisis Line. Butthe amount of calls that I know
that they get, the work thatthey do, and some of the stories
(10:30):
that we've heard coming out ofthat has got to be making a
difference somewhere. And, youknow, finally, the, you know,
that sense of belonging, if aveteran reintegrates, like you
talked about a reverse bootcamp, when veterans reintegrate
back into into the into thesociety, I think that we as a
community, I know that veteransrecognize this, but the society
(10:53):
has to remember that theirentire life has changed. And
it's changed in a way that it'snot only their career, but it's
their support network. It's theit's the culture that they used
to operate in, whether it was acombat culture, or just being on
base. They've been, essentiallyair dropped back into society.
(11:15):
And it takes it takes a periodof readjustment. And if that
readjustment doesn't go, well,it's really just going to
contribute to the veteran notbeing as as successful, which
can also contribute to divorcerates, unemployment. And then
ultimately, in some cases, verytragically, veteran suicide.
Dr. David Shulkin (11:33):
I think these are such important points low I
think, you know, your pointabout the veteran crisis line, I
can't imagine a harder morestressful job than being a
person who answers that, thatblind in on the phone all day
long. And I've spent time withthe Veterans Crisis Line
responders, these are amazingpeople. And where else can you
(11:55):
find somebody to talk to atthree o'clock in the morning,
so. So I have no doubt that theyare part of the solution here.
The other thing that youmentioned was the interaction
with the community. As we know,the vast majority of veterans
that take their own lives aren'tgetting care in the VA system,
(12:16):
they're out in the community. Sothey're interacting with, you
know, their neighbors, withtheir churches and the Veteran
Service groups, and you know,people at work. And so getting
people to recognize whensomebody needs help, and being
there to reach out to them to bethat listening partner, I think
(12:36):
is so important. And that's whythese educational efforts, and
even things like our podcaststhat's talking about it is
educating people as to why thisis so important.
Louis Celli (12:46):
I couldn't agree more. So let's, let's get Ben in
here. And let's let's go throughsome of these issues that he
talks about, you know, like themoral injury in the sense of
belonging. And when veteranscome back, if if they don't feel
like they're a valued member ofthe society. One of the top
things that we've heard, and I'mnot even sure if it's outlined
(13:07):
in this paper or not, but I'veheard it time and time, again,
is that when veterans haveincomplete suicides, and we're
able to interview them, whatthey often say, or what they
leave in notes are things like,I didn't want to be a burden.
And they feel like they're beinga burden, they don't feel
useful. And that is somethingthat we can all address. That's
(13:27):
something that we can address
Dr. David Shulkin (13:29):
today.
Couldn't agree more. So whydon't we get started? Let's do
that.
Louis Celli (13:41):
Ben, thank you for joining us today on the policy.
That's podcast.
Dr. Ben Suitt (13:44):
Thank you so much for having me, Lou. I really
appreciate you inviting me on.
Dr. David Shulkin (13:47):
Ben. Good morning. Thanks for being on
with us. Can you start by justtelling us why you decided to do
research about veterans suicide?
Dr. Ben Suitt (13:56):
Yes. So I was working on my dissertation work
at Boston University and theReligious Studies Department.
And I was looking at the role offaith in the lives of post 911
veterans. And so oftentimes,faith would be something that
was very positive for them. Butit could also be something that
could end up being damaging. Soif you imagine being told your
(14:17):
entire life, that killing iswrong, and then you find
yourself in a position where youare killing others, this could
be something that could upendsort of your view of religion in
the world, and your relationshipwith God. And so in looking at
that, I spoke with over 50veterans and military chaplains
about their experiences. Andsomething that became very clear
(14:38):
was that the majority of themhad stories of trauma, and those
that didn't, certainly knewothers who had one of my mentors
Professor Nita Crawford, who wasworking on tallying up the
actual cost, like financial costof the wear and tear. She knew
that I was working on a conceptcalled moral injury. And
(15:00):
relating that to the stories offaith and trauma that I heard.
And so she asked me to look intothe mental health costs of the
post 911 wars. And what becameclear was the way to talk about
that was to talk about theincreasing rates of suicide,
particularly when I got my handson the data.
Louis Celli (15:16):
Yeah, one of the things that I really appreciated
about the paper is that you'vedone a really good job in
collecting information just froma variety of sources. So what
did you find to be the mostdifficult data to procure, and
what data surprised you themost,
Dr. Ben Suitt (15:32):
and the most difficult data to procure was
the Department of Defense dataonly, because if you look at
their annual reports, they willso they will show trend lines,
but they don't necessarily showall of the data over the years.
And so I did have to put in arequest with the department
defense suicide event report.
And eventually, the defensehealth agency got back to me
with those exact figures. One ofthe difficulties there as well
(15:56):
was that they've only reallyconsistently begun counting
suicides since 2008. And they'veonly had a consistent scale and
way of adjusting those ratessince 2011. So the data there is
difficult to put together,particularly because before
(16:16):
2008, you had this sort of broadcategory called self inflicted,
but self inflicted isn'tnecessarily suicide, that could
be a car wreck, or a weaponmisfire, drug overdose. And so
there's a bit of piecing thepast together to be able to get
the right denominator and get anaccurate number for suicide. But
the most surprising dataoverall, was really just the
(16:40):
putting the sheer volumetogether when I was even looking
at the veteran data, the VAdoesn't separate their data by
era of war. Which makes sense, alot of Gulf War Veterans also
fight in post 911 wars. But itdoes make it tricky, trying to
piece together those numbers.
(17:02):
And so going by agedemographics, and then also
comparing that with thepercentage to total that we know
of veterans who fought in post911 wars. When those numbers
came back and realizing thatwe're talking about over 30,000
post 911 era veterans and activecomponent servicemembers dying
(17:22):
by suicide compared to the thetermite report 7057
servicemembers who died inmilitary operations, it's it was
just absolutely staggering. Andjust to update their the the
current number as of September6, for those that have died in
military operations is 7074.
Dr. David Shulkin (17:41):
For a while now the VA Department of
Defense, the President, Congresshave really prioritized veteran
suicide and have put theresources into programs have
worked hard to make thissomething that they're really
working on. So you say in yourpaper that we need to do more,
(18:02):
what do you think the VA theDepartment of Defense the
Congress needs to be doing inorder to do more?
Dr. Ben Suitt (18:09):
That's a great question. The I think, in a
broad term looking at this, itwould be that we need to be more
proactive rather thanreactionary. So the way the
system is set up right now isthat we pour billions of dollars
into the VA to help veteranswith suicide. But the amount of
spending that we put into theactual armed forces for suicide
(18:32):
prevention is just a drop in thebucket. It's nowhere in the
realm of what we spend forsuicide prevention. With the VA.
It comes down to this sort offrustrating aspect that the
Department of Defense likes touse this logline I talked about
in my report, but that becausethe suicide rates among active
component service members areabout the same as those in the
(18:55):
civilian population, thatthere's not a problem, except we
know historically that the ratesof active component service
members are lower than that ofthe civilian population and
tended to go down in wartime,after World War One, except for
Vietnam, and now post 911 wars.
So that rate has come to meetthe civilian population. And
looking at the most recent data,it looks as though it has
(19:18):
surpassed the civilian rate.
They haven't released numberssince 2018. They do have a
problem on the front end thatthey do need to be focusing on
the Department of Defense in thearmed forces. They're very good
at, you know, maintaining theirweapons, taking physical fitness
very seriously. But they're notso great at looking at mental
health as a force multiplier,and realizing that just as they
(19:41):
service their weapon andmaintain their physical fitness,
they need to be taken care oftheir mental health as well.
Louis Celli (19:47):
Your paper is is pretty relevant. You dropped it
last month. And then right afterthat, as you mentioned, the VA
has dropped some recent data tocover 2018 so My question is it
looks like from VA is morerecent data, that the the number
(20:07):
of daily veteran suicides hasactually dropped from from 18 a
day to 17 a day. But accordingto your research, they're not
really counting all of theveteran categories. Can you
explain that
Dr. Ben Suitt (20:18):
the data used to say that 22 veterans died per
day, they've been adjusted theway that they count veterans.
And so the 22 a day was countingjust a brighter category. So it
could be national gardenreserves, who were never
federally activated a broaderpart of the military, that just,
they decided didn't quite countin terms of those veteran
(20:39):
numbers. So when they made thatadjustment, it did bring it down
to 18. And it does look likeit's gone down to 17. So when
you try to look at those broadernumbers, for just those in the
reserves and National Guard, whomaybe were not federally
activated, they, the Departmentof Defense would point you to
sort of civilian records,because they civilian records
(21:01):
would show whether they died bysuicide, but that wouldn't be
captured in the Department ofDefense records.
Dr. David Shulkin (21:06):
Well, why do you think that they made a
switch in the way that theycount, because when they were
counting it as 22 veterans, theyincluded the National Guard, and
then they changed it, and insome cases have been claiming
that this is progress. But whatyou're saying is this is really
(21:27):
just looking at two differentgroups of of people instead of
keeping it with this similardefinition. So what's your
explanation why they changed theway that they count us?
Dr. Ben Suitt (21:40):
One of the reasons was that, before they
made that switch, there mighthave been potential overlap
between the Department ofDefense reports and the VA
reports. I think they're alsoworking on trying to have a more
consistent denominator with whothey're counting. And in
addition to that, they areprobably not counting them,
because they are trying to keepthe focus on what problems might
(22:02):
be unique for veterans, theymight put those suicidal
problems up to societal issuesrather than military issues. I
don't know that that's correct.
I think that being involved inthe military organization is
going to affect your life insome way. But I think that
that's probably their logic.
Louis Celli (22:21):
Tell us some stories about the veterans that
you've interviewed some of thesome of the folks that you spoke
with, what our listeners reallywant to hear is they want to
hear, you know, kind of thatthat personal interaction, and
the numbers are important. Theywant to, but they want to hear
really about the human stories.
And I'm curious, what are thenumbers today, right? So if
(22:42):
they're not counting everything,and your research has been able
to kind of tease out thatthey've missed, really some
categories, or you know, justnot even looking at it. If we
were to add all the categoriestogether, what would those
numbers look like today,
Dr. Ben Suitt (22:59):
adding those numbers up together does look
like about 30,177 is my veryconservative estimate of how
many may have died. The reason Iwent with a conservative
estimate is just making surethat I'm not overstating because
that wouldn't end up beinguseful. But to your point about
stories of that I've heard Imean, I, I sort of opened my
(23:20):
report with Ford observer, hewas in Cedar City at a sort of
very violent time and chosenfive and afford observer. They
like to call themselves sistersor Pfister's. But they do have a
very dangerous job having to gosort of deep into enemy
(23:41):
territory to make those callsabout where to aim artillery.
The officer that I was speakingwith, he realized that the
youngest in his sort of unitthat he was in charge of caring
for died, and he felt personallyvery guilty for it. He said that
he remembered praying to God,and asking for God to protect
(24:04):
his men. And when that young mandied, he said it just absolutely
destroyed his his worldview andhis faith. But he said the real
work actually came when he camehome. He finally had a sort of
the ability to reflect on hisexperiences, and for the first
time, realize what hisexperiences did to him and his
(24:28):
in his life, and he developedsuicidal ideation and post
traumatic stress had moralinjury. More than that, when he
started speaking with otherpeople in his unit, he realized
that they were having adifficult time too. And at the
time of speaking with me, herevealed that more people in his
unit had died by suicide thanever died in combat, despite
being in Seder city in such adangerous time. And when I
(24:51):
looked at his story, and otherstories of people I spoke with
it became clear that many ofthem had similar stories.
Realizing that people in theirunit had died that they knew
people had died by suicide. evenlooking at Iraq and Afghanistan
Veterans of America data, itseems that well over 60% of
(25:12):
veterans who fight and post 911wars, know someone who
successfully attempted or hasattempted suicide, if if they
didn't attempt it themselves.
Dr. David Shulkin (25:23):
One of the challenges of the data that you
talk about, and the data thatyou had to get from VA and the
Department of Defense is that itlags by a couple of years, I
think the report that just cameout is 2019 data. So it's two
(25:43):
years old. And of course, a lothas changed in these past two
years, we've had a pandemic,we've now disengaged from
Afghanistan, which has had a bigimpact on many of our veterans
who have served in the recentconflicts. So what do you think,
(26:03):
has happened to the suiciderate? in these last couple
years? What do you think we'regoing to see two years from now?
And what do you think the impactof both the pandemic and the
withdrawal from Afghanistan isgoing to have on the suicide
rates?
Dr. Ben Suitt (26:19):
So the numbers that came out, just this past
week from the VA, wereheartening, because it did show
that the rate even among the 18,to 34 demographic, which tends
to that is certainly thedemographic that has the most
post 911 veterans, that thoserates have gone down the lowest
numbers that it's been since2015. So that is great. But to
(26:43):
your question, it's hard to knowhow the pandemic is going to
affect that when I spoke withMatt Miller, who's the national
director of suicide preventionat the VA, he said, the raw data
coming in looks like it mightcontinue to go in a downward
trend, I'll be very interestedto see if that's actually true.
But if you look at just thetotal number of people who die
by suicide, it's going to looklike the 55 to 74 demographic is
(27:08):
hurting the most. But when we'relooking at this data, it's
really important to think aboutthe rate per 100, or 100,000,
not just the lump sum totals.
And so the demographic that'shurting the most is that 18 to
34 demographic, realizing thepandemic is going to have an
effect, I think the thing that'sreally going to have an effect
is this pulling out ofAfghanistan, one of the things
(27:29):
that's been going around in thenews, and the Daily Beast was
the first to sort of break thestory, but the the call volume
to the national veteran suicidehotline has been increasing
since the pulling out ofAfghanistan. And that does seem
to be an indicator that we arewrestling with more suicidal
(27:50):
ideation at the moment. And itwill be really important to see
those 2021 numbers when everthey do catch up.
Louis Celli (28:00):
You know, you've mentioned moral injury Now a
couple of times and and I wantto drill down on that something
that I really found to be veryhelpful in your writing in your
paper, was the fact that youactually list a variety of
different stressors thatcontribute to veteran suicide,
which is something that thatother papers really don't
(28:24):
highlight that as much and Ithink that that's important. Can
you talk a little bit about that
Dr. Ben Suitt (28:28):
about moral injury specifically,
Louis Celli (28:30):
not just about moral injury but you know,
there's a there's a list moralinjury, loss of purpose divorce,
a nation that doesn't get it, Ithink that's extremely
important. Veterans a wonderingif their sacrifice was worth it.
One statistic that did surpriseme was the number of adults that
you that were polled thatactually thought that the war
was over years ago. I mean, thatthat really surprised me. So can
(28:53):
you talk a little bit aboutthat?
Dr. Ben Suitt (28:55):
Absolutely. So when I looked at the the
possible causes for increasingrates and suicide, I realized
that there were we couldcategorize them into two
different parts. So on the onehand, you have things that would
be novel to the post 911 wars,and on the other hand, you would
have things that might be trueof all wars, and what those
things that would be unique tothe post 911 Wars post have
(29:16):
words were characterized withjust a tremendous increase in
the number of improvisedexplosive devices on the part of
enemy forces. So this would justitself create an enhanced state
of fear or stress burden onservicemembers that that alone
could increase suicidalideation. But for those that
experienced improvised explosivedevice explosions, this led to a
(29:38):
tremendous increase in thenumber of traumatic brain
injuries. But what we also hadwere incredible medical advances
that meant that if a person hada traumatic brain injury, they
were also likely to be able tobe redeployed, because we're
able to help them. The issue isthat IEDs were used to such a
degree that traumatic braininjuries became It was called
(29:58):
the signature injury of The waron terror. And so servicemembers
would come back with a traumaticbrain injury and then be
redeployed. And this wouldhappen over and over to the
point that the sort of theaverage was around three. But
the higher estimates were 15traumatic brain injuries and
still being redeployed. Andanecdotally, with veterans I
(30:20):
spoke with, they would say, Oh,I knew a guy who had 20. So
fortunately, soldiers andservice members are surviving.
Unfortunately, having increasedtraumatic brain injuries that
compound on one another, thatseverely increases the rate of
suicidal ideation among thatgroup, in addition, that if
you're surviving injuries thatmight otherwise take you out of
(30:41):
the fight, but you're able toredeploy, you might develop
chronic pain. Also, justexperiencing trauma, you're
going to have your body'snatural response to trauma,
which is what we call PostTraumatic Stress Disorder, but
it's just that deep in theamygdala, you're able to
continue to have this fight orflight response that just won't
shut off. And so those threetogether we call poly trauma or
(31:03):
the clinical triad, and that isvery closely tied to increasing
rates of suicidal ideation. Inaddition to that, you have what
is similar to what happened inVietnam, but it is unique to
post 911 wars. It's just thestereotypes and the societal
burden of being a veteran. Andso in Vietnam, it would be that
(31:27):
they would call returningveterans, baby killers or awful
things like that the point thatveterans of Vietnam felt like
they were never welcomed homethat they were outside of
society, what it was like forpost veterans is coming home,
that they would be treated asheroes, even those that didn't
feel as though they had donethings that were heroic. But at
(31:48):
the same time when they'retreated like they were
necessarily broken people thatcan make them feel as though
they're outsiders to society.
But couple that with the thepoint, you mentioned that 42% of
the voting public in 2018,didn't realize we were still
fighting the war on terror, thatcan also cause a bit of an issue
when your identity is wrapped upinto the fact that you fought in
(32:09):
the war, that you gave up a partof your life, and you come back
to a public that is so deeplyapathetic to what's going on,
that they don't even realize thesacrifices you've made. And I
think that that does end uptying to what's going on with
pulling out of Afghanistan. It'sjust this idea that, you know,
(32:29):
if it's a big part of youridentity, that you were doing
good work, or that what you didhad a purpose. And suddenly,
we're leaving the nation,basically, where we found it
either worse off or about thesame. That that can sort of
disrupt this narrative that wewe all carry that I'm a good
person, I'm doing good work. Ifyou suddenly feel as though all
(32:52):
of your life's work or thesacrifice, you made work for
nothing that can enhancesuicidal ideation.
Dr. David Shulkin (32:59):
I want to go back to clarifies some of the
discussion that that you weretalking to us about before about
whether being in combat actuallybeing deployed into an area with
conflict? is a risk factor forsuicide? Or is it actually a
(33:22):
protective factor? And are weseeing more suicides on the
people that aren't deployed? Canyou just clarify that?
Dr. Ben Suitt (33:30):
Yes, there's some nuance there. So when we look at
the rates among those in combatroles versus those in support
roles, depending on the year, itcan look like the rates among
support roles are higher thanthose in combat roles. And so
something that I've seen in areport before was that being in
combat might be a protectivefactor that is, would only be
(33:53):
true to a very specific point.
So we know that witnessingatrocities or perpetrating
atrocities yourself, do increasesuicidal ideation, and suicide
risks. So it's sort of like thetype of combat would make a
difference. So if you'veexperienced atrocities, or if
you have perpetrated violenceyourself, those suicide rates do
go up. But it is an importantpoint to bring up that you don't
(34:16):
need to be in combat to havehigh suicide rates. So those in
support roles do have highsuicide rates. That can be for a
number of reasons. One can besecondary trauma. So being in a,
an organization that does a lotof good, but also does a lot of
violence can increase your riskfor suicide. But one important
issue to bring up is alsomilitary sexual trauma, which is
(34:38):
a unique form of sexual traumabecause the victim often has to
continue working with theirattacker and this affects both
women and men. But especiallywomen that is certainly linked
to the development of posttraumatic stress, but also it's
a an indicator of risk forsuicide as well. Just milk
(34:58):
sexual trauma,
Louis Celli (35:01):
in addition to the data in your paper that talks
about the higher, higheraccounts of suicide among
veterans who were not deployed,you also talk about the highest
amount of suicides among Guardmembers. Can you talk a little
bit about that?
Dr. Ben Suitt (35:18):
Yes. So while my, my report doesn't focus as much
on the National Guard, it doesappear depending on the year
that the National Guard rates dotend to be among the highest, if
not the highest, often sort ofneck and neck with the army,
those rates do seem to be up. Ithink one of the things in post
911 Wars specifically is thatthe National Guard was deployed
(35:41):
under the purview of the army,that the National Guard would be
put into positions that maybewhen they sign up for National
Guard, they weren't really theydidn't suspect that they would
be called upon to have boots onthe ground and be fighting. In
that way. One of the NationalGuard men that I spoke with his
job was just he was going to bejust doing sort of operational
(36:03):
management dealing with supplylines. And when he was deployed
to the Middle East, he realizedthat they were going to be
changing his role. So where hethought he was going to be doing
operational management,suddenly, they were putting him
on convoys, and putting theminto war zones, and he was going
to have to fire on the enemy.
He's specifically said that henever signed up for that,
(36:24):
obviously, you know, going tothe military, you're certainly
trained to use your weapon. Buthe wanted to seek out support
roles, he never wanted to haveto kill someone. And now
suddenly, he found himself inthat position, it did end up
sort of wrecking his hisworldview. And it's just such a
tragic story, because being putinto a position where when you
(36:45):
signed up, and you're makingthat commitment, but you did
specifically sign up forNational Guard, knowing what
that would look like, theNational Guard tends to be one
foot in the military and onefoot in the civilian world,
having that significant rolechange. I just can't imagine
what that would do.
Louis Celli (37:04):
We could cover your paper for the next hour and a
half. I mean, it's very rich anddata. As a matter of fact, we're
going to go ahead and post it onour website. Before we go, I
want to ask you, what can we asa community, VA, the government,
what can we be doing better?
Dr. Ben Suitt (37:21):
In terms of civilians, I think that the what
we can do better is to inviteveterans into our communities,
it is shown that even justreaching out lowers suicide
rates. So showing care. ThatRasmussen study that showed 42%
of the voting public didn'trealize we are at war is so
(37:42):
upsetting that it's just absurd.
So showing care, being involvedin veteran lives, coming back to
the civilian world is difficult,you know, your identity changes,
when you enter the military, youbecome a warrior. And having to
come back to the civilian world,you know, the change back to
being a civilian doesn't happenovernight. And it would
certainly help for civilians tobe involved in that. In terms of
(38:03):
the VA, I think they need to tryto begin taking more holistic
approaches, they tend to focuson one specific piece. But as my
report shows, taking care of onepiece is not going to solve the
problem, we have to look at itfrom so many different angles.
And in terms of the Departmentof Defense, they need to take
(38:27):
suicide prevention moreseriously. And think about ways
to reframe it so that activecomponent service members take
help seeking attitudes moreseriously.
Louis Celli (38:39):
Then that really covers the question that I was
going to ask you last before weleft and that is to summarize,
you know, your your, yourresearch in your report in about
two sentences, but you just dida perfect job. Listen, I really
want to thank you for joining ustoday and absolutely time to to
speak with us.
Dr. Ben Suitt (38:57):
Thank you so much for having me. I really
appreciate it.
Dr. David Shulkin (38:59):
Thank you.
Louis Celli (39:03):
Well, that's gonna be it for today. Hey, join us
next week we have a very specialguest the honorable Randy
Reeves, who's the former VAUndersecretary for Memorial
affairs. He was also the statedirector for veterans affairs in
Mississippi. And he's going totalk to us about state veterans
homes. When veterans die instate Veterans Home who's
responsible? Find out next week.
Announcer (39:27):
Thanks for listening to the policy. That's podcasts.
For more information aboutprojects and other podcasts, go
to policy. That's dot org.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!