Brief Preventing Military Veteran Suicides: State Policy Options

The 2020 U.S. Department of Veterans Affairs (VA) report on military veteran suicide, catalogs 17.6 veteran suicides per day in 2018. This amounts to 6,424 veteran lives lost to suicide annually, increasing steadily each year from 6,056 in 2005. These unacceptably high numbers are part of an ongoing and vexing public health problem in the United States.

As reported in a March 2021 article using The Centers for Disease Control and Prevention’s (CDC) data, suicide accounts for nearly 45,000 annual deaths. Suicide deaths had steadily increased across the country between 1999 and 2018, with 2019 and 2020 showing declines from prior years.

A recent study of suicide risk and mental disorders states that “most suicides are related to psychiatric disease, with depression, substance use disorders and psychosis being the most relevant risk factors.” Veteran suicidal behavior is complex, according to a recent American Legion study. Multiple factors contribute including post-traumatic stress disorder, traumatic brain injury, loss of a sense of purpose, loss of a sense of belonging and substance abuse. Additionally, the warrior ethos may be a contributing factor in veteran suicides and among active-duty service members.

A recent analysis of female veteran suicide characterized the warrior ethos this way, “The warrior ethos is a code of conduct where integrity, loyalty, selflessness, and courage are one’s guide. While this ethos produces a superior fighting force, it also produces a culture that sees mental health issues as a source of weakness,” thus creating stigma and preventing military veterans from seeking support in situations of mental health instability and suicidal ideation.

State Action

Suicide is a preventable cause of death. States, local governments and the federal government are implementing a variety of strategies to reverse its escalation. The federal government handles most mental health needs for veterans through the VA, however, states are also acting to address and prevent veteran suicide.

Veteran suicide prevention legislation in state legislatures focuses in several policy areas. These include enhancing treatment, early detection and training of state personnel who interact with veterans; collection of better data on veteran suicide and the efficacy of existing state programs; establishing one-stop websites and offices where veterans can access various services in a streamlined manner; and establishing commissions and/or task forces to conduct comprehensive studies of all services and benefits provided to veterans.

Specific state approaches include:

• Delaware, Kentucky, Texas, West Virginia and Wisconsin operate Green Alert programs. Green Alert programs for missing veterans provide law enforcement with additional tools to help respond to at-risk veterans’ disappearances.  Similar to an Amber Alert, a Green Alert notifies the public when a veteran or military service member is missing who has a physical or mental health condition that could put them at imminent risk of self-harm. Other states including Colorado, Connecticut, Iowa and Tennessee have also considered such programs and legislation for a national program was considered by the U.S. Senate in 2019.
• Several states have created programs for voluntary reduction of access to highly lethal means of suicide, such as firearms and dangerous medications, for individuals considering suicide. Reducing access to the most lethal means has been shown to decrease rates of suicide. One approach is the Gun Shop Project, in New Hampshire and at least 20 other states, that provides gun stores and firing ranges with suicide prevention materials tailored to their customers. In Colorado’s program, designated firearm advocates visit members of the firearm community to promote temporary safe storage as a proven suicide prevention tool, since studies show that suicidal crises are often brief, usually less than one day. Thus, temporarily keeping lethal means away from a person in crisis saves lives. Utah’s HB 390 created a Suicide Prevention Education Program to fund suicide prevention activities by federally licensed retail firearms dealers that includes information on crisis intervention resources and how to identify persons who may be suicidal.
• Over 500 veteran treatment courts (VTCs) are in operation at the state and local levels. Designed for veterans involved with the criminal justice system due to substance use and/or mental health disorders and trauma, VTCs are modeled after mental health and drug courts, which emphasize connecting justice-involved veterans to the benefits and treatment available from state, local and federal programs. To further encourage adoption of VTCs, the August 2020 Federal Veteran Treatment Court Coordination Act (P.L. 116-153), provides funding and assistance to states, tribes and local governments to start or expand VTCs.
• Washington passed HB 15-1424 in 2018 requiring all medical health professionals to undergo suicide prevention training specific to veterans and HB 18-6514, which requires higher education professionals to receive training for identifying and intervening with student veterans at risk of suicide.

Federal Action

The VA manages numerous programs that address veteran suicide through the provision of mental health care. The focus is on identifying and treating mental health conditions at their earliest onset, addressing acute mental health crises, and supporting recovery. The VA employs hundreds of suicide prevention coordinators, mental health professionals specializing in suicide prevention. An in-depth VA National Strategy for Preventing Veterans Suicide maps out an approach to reduce suicide rates by 20% by 2025.

The Federal Communications Commission is implementing the National Suicide Hotline Designation Act of 2020, which establishes the national “988” Suicide Prevention Lifeline number for rollout by July 2022. The three-digit number is easier to remember and builds on the existing infrastructure of the National Suicide Prevention Lifeline. The hotline will also include the existing Veterans Crisis Line.

The Substance Abuse and Mental Health Services Administration (SAMHSA), with the VA as a partner, developed the Governor’s and Mayor’s Challenges to Prevent Suicide Among Service Members, Veterans, and their Families. Twenty-seven states and 18 communities are developing and implementing suicide prevention best practices for service members, veterans and their families, using a public health approach, while engaging partners across various stakeholder groups.