Health care and VA officials struggle to find solutions to combat veteran suicide

On a cold day last December, Charlie Monroe was preparing to leave Mann-Grandstaff VA Medical Center when he noticed a man staring at him.

“He was distraught. He was not in a good place,” said Monroe, a 68-year-old veteran from Spokane. “I asked him, ‘You all right?’ He said, ‘No. Not really.’ It was easy to spot.”

Monroe, who has had some crisis training, said the troubled veteran relayed how he had gone to the VA hospital’s urgent care but he was turned away with instructions to call the national Veterans Crisis Line.

Monroe invited the veteran into his truck to warm up and they talked for 45 minutes about the man’s family issues and his trouble keeping a job.

“Sometimes they just need a hand on the shoulder or eye contact,” Monroe said. “Or, just seeing another face that shows some concern. I got him to settle down.”

It’s those crucial moments that are key to turning a suicidal veteran into someone willing to seek the counseling they need to address their problems, said psychologist Quinn Bastian, the chief of Behavioral Health Services at Mann-Grandstaff.

“Our first goal is to ensure their safety. That’s our top priority,” Bastian said. “Even the crisis line will call police to their homes sometimes to make sure they are safe. Once safety is assured, the next goal is to make sure they are engaged with good, solid mental health care.”

Providing immediate care for suicidal veterans was the focus of testimony Tuesday in Washington, D.C., after a March 20 audit by the VA inspector general found nearly a third of the calls to the Veterans Crisis Line late last year were being bounced to backup centers operated by an outside contractor. Those rollover calls sometimes caused waits of 30 minutes or more during the veterans’ most vulnerable moments.

Some 20 veterans take their lives each day in the U.S. and new VA Secretary David Shulkin has made suicide prevention a signature issue at the troubled agency.

Along those lines, Steve Young, the VA’s deputy undersecretary, told a House panel Tuesday that many of the hotline problems had been fixed since November and it is now a “rare instance” when calls are bumped to the backup center, according to Associated Press reports.

The crisis hotline “is the strongest it has been since its inception in 2007,” Young told the House Veterans Affairs Committee.

Lawmakers were unconvinced.

Minnesota Rep. Tim Walz, the top Democrat on the House panel, pointed to “re-occurring issues we see time and time again at VA.” For more than a year, the crisis hotline has operated without a permanent director and has yet to issue a policy handbook.

“I would be very careful in saying you fixed the problems,” Walz warned, according to AP.

Rep. Phil Roe, R-Tenn., a physician who chairs the House committee, questioned whether the VA intended to fully implement reforms after repeated promises.

“There is very clearly a need for more to be done – and soon – so that we can be assured that every veteran or family member who contacts the VCL gets the urgent help he or she needs every single time,” Roe said.

Every consult gets a call

As for the man Monroe described last December, Bastian said he was unaware of the situation Monroe described.

“It would surprise me to learn of a veteran coming to urgent care and being sent away without help,” Bastian said. “We do have a psychiatric triage team specifically set up to do this.”

Sometimes veterans come in and they are determined not to be in a crisis at that moment and are then asked to call the crisis line “if things get worse and they are not feeling safe. That is something that we do.”

Launched in 2007, the crisis hotline has answered nearly 2.8 million calls and dispatched emergency services more than 74,000 times.

Every call received by the hotline gets routed to call centers located in either New York or Atlanta. Those veterans who call are then referred to the closest VA facility.

Bastian said Mann-Grandstaff receives between 10 to 20 referrals, called “consults,” from the hotline each week.

“We have a team checking every day looking for consults and responding,” he said. “A lot of consults we get are routine, like veterans wondering about the process or … wanting to start care with a counselor. But, we are going to respond to everyone who comes in.”

The facility is somewhat limited on time. Urgent care is open from 8 a.m. to 6 p.m. each day. Veterans seeking a personal visit in the evening have to wait until the next day.

“The crisis line provides us with a number. We can’t always connect immediately. Sometimes the calls don’t go through or we can’t reach them,” he said. “But we follow up to make a solid effort to reach the veteran that day or follow up the next day.”

As for the troubled veteran from the December incident, Monroe said he later talked with him and learned that he had received further counseling from the VA.

“He thanked me for all I did,” Monroe said. “The thing is, he just needed somebody. Sometimes just talking on the phone doesn’t do it.”

The Associated Press contributed to this story.