The Price of Service

feet of a veteran with his backpack and shoes and an american flag in the backgroundWith all eyes on the opioid epidemic, the suicide crisis has been allowed to quietly loom without much notice. In 1999, suicide rates began to trend upward among all age groups. Nearly twenty years later, this trend has not only persisted but has accelerated. Since 2006, the national suicide rate has increased rapidly, as much as doubling for some age groups, even while the other leading causes of death remained steady if not declined. As a result, suicide is now the second leading cause of death—what some might refer to as “preventable death”—among young people and adults 15 to 34, and the third leading cause of death among adults 35 to 44.

Military veterans have proven to be particularly vulnerable to suicide. The US Department of Veterans Affairs (VA) places the suicide rate among veterans[1] at approximately 1.5 times that of the non-veteran adult suicide rate. Acknowledging this crisis, the VA has recently enacted several key prevention initiatives to target and reduce suicide risk based on the best, current evidence available. However, there is still much to be done before we can start making inroads.

As Dr. Julie Baldwin noted in our September issue of Veterans’ Justice and Mental Health newsletter, an important first step is to be able to recognize the signs and intervene in the lives of people who are going through crisis. In addition, there are larger systemic issues that must be addressed. For example, identifying former service members in contact with our various public health institutions, including within the justice system, has been notoriously difficult. Not only does identification bring to light a potentially important risk factor, the possibility of added VA eligibility may aid in the provision of treatment.

Another important issue that, I believe, must be addressed before we are able to effectively address this crisis tends to be a controversial topic. Specifically, I am referring to the role of firearms. Suicide is often a spontaneous decision, therefore, easy access to firearms during a crisis can be highly lethal. Nearly half of all cases of veteran suicide involve a firearm, which increases to nearly three out of four cases when limited to male veterans.

While numerous studies have shown that limiting access to firearms appears to be an effective means to reduce deaths by suicide, there is reluctance, if not strong opposition to pursuing this preventative approach. The US gun safety debate is a sharply divisive and unresolved issue today.

However, I believe it is possible to strike a balance between current broad accessibility to firearms and small measures aimed to temporarily limit access when medical professionals or other qualified decisions makers deem it essential for continued health, wellbeing, and treatment—this would be a small step in the right direction.

If we really want to start making a difference, it is time to start making some hard decisions. It is time to stop doing what is easy, and time to start doing what is right by our current and returning service members because the price of service should not fall wholly upon those with the courage or motivation to serve their country.

[1] They define “veteran” to exclude current service members and former National Guard or Reserve members, and therefore do not count them among these statistics.