In the fight to reduce the incidence of suicide among veterans it is important to understand and deal with the various risk factors. We have known for years that social isolation is a risk factor for suicide. Not interacting with others increases suicide risk. An important subset of this risk factor is not interacting with health care personnel. There is a definite relationship between health care access and suicide risk. This applies to mental health visits as well as simply going to see the doctor. More than half of veterans who commit suicide have not had a health care visit in more than a year.
Community Health Care Access and Suicide Risk
Going to see the doctor or going to see a mental health professional is a lot easier if there are health care services in one’s community. It also helps if they are affordable. Military veterans can get health care and mental health care from Veterans Administration facilities. The General Accounting Office looked at access to VA facilities and especially use of VA facilities as it related to how far a person lives from the closest facility.
They found that living within five miles of a VA facility greatly increases veteran use of a facility. This applies to only 11% of the veteran population. for VA hospitals and 17% for hospitals or VA clinics. The use of VA facilities for veterans living as far as 100 miles away increases significantly for those with service-connected disabilities, pensions, or other forms of VA reimbursement for their care.
Several studies have shown that the absence of health care in a community increases the incidence of suicide. Likewise, the lack of mental health facilities has the same effect.
Why Don’t Vets Visit Their Doctor?
For most veterans who do not go to a doctor the issue is not distance from a health care facility. It may have to do with cost but that is also not the main issue. Women go to the doctor for Pap exams and to get birth control pill refilled. They are generally in charge of getting the children to the doctor as well. And women are generally more accustomed to talking about health care issues. Men often have a sense that they should not be vulnerable which keeps them away from doctors. They also typically do not think of the issues that should be addressed like cancer checkups. In the case of a veteran who is at risk for suicide, depression, PTSD, and substance abuse issues all work toward preventing the person from seeking help. This later group includes both male and female veterans.
Getting Veterans to See a Health Care Professional
For socially isolated veterans the first issue is typically getting the vet to interact with people. Engaging them in activities that get them out of their isolation. Then it is important to bring up issues of self-care. Veterans are trained to be resourceful, strong, and self-reliant. This mindset can be an impediment when a veteran needs help, even just to have someone to talk to. Many who leave military service have had negative experiences which prevent them from wanting to engage with any military-related person or institution which often includes the VA system. However, that does not preclude going to a local family physician. The important part is getting the veteran at risk motivated to make necessary changes in their lives that result in dealing with their suicide risk issues.
Health Care Providers Need to Bring Up Issues of Suicide Risk With Their Patients
Many times in medical practice a man comes to the doctor for an injury or temporary illness, is treated, and discharged. Whatever potential health risk issues they have, they are never dealt with. It is important for health care providers to make a point of bringing up health care and mental health issues as appropriate. This is especially important in military veterans who appear to have substance abuse issues, service-connect disabilities such as PTSD or traumatic brain syndrome, depression, relationship issues, or impulse control problems. In many cases a busy general practitioner does not have the time to deal with such issues in depth but can often make a referral to someone who has the time, training, and availability to help the veteran in need.
This last bit of advice applies to all of us who know or interact with veterans from time to time. A kind word, a simple question, can make all of the difference is getting a vet connected to the services that are likely to prevent a veteran suicide.